To Study the Efficacy of Homoeopathy in the Management of Irritable Bowel Syndrome (IBS)
by Dr. Parth Aphale, MD (Hom.)
Abstract:
Irritable Bowel Syndrome (IBS) is defined as a gastrointestinal (GI) disorder characterized by altered bowel habits and abdominal pain in the absence of detectable structural abnormality. (Ref. Harrison)
IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines. Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, or even travel short distances.
Methods:
30 cases of IBS were studied satisfying the case definition.
Inclusion and exclusion criteria were laid down.
Assessment criteria were laid down.
Results:
Observations with respect to age, sex, occupation, remedies were documented and the efficacy of Homoeopathy was analyzed in these cases.
Conclusion:
Homoeopathy is useful in treating cases of IBS.
Keywords: IBS, Structural Abnormality, Homoeopathy, Intestines.
Introduction
Irritable bowel syndrome (IBS) is important because of its high prevalence, substantial morbidity and enormous costs.
IBS is characterized by the presence of abdominal discomfort or pain associated with disturbed defecation.
Bloating or visible abdominal distension often are present in patients with IBS but are not considered essential symptoms for diagnosis. It’s now proposed with subsequent studies that the Rome criteria can be used in clinical practice with success
Comparison of the Major Diagnostic Criteria for the Irritable Bowel Syndrome[1]
Clinical Features
Abdominal discomfort or pain: IBS should not be diagnosed in the absence of abdominal discomfort or pain. The pain or discomfort in IBS typically is relieved by defecation, or its onset is associated with an increase or decrease in stool frequency or looser or harder stool. The pain often is poorly localized, waxes and wanes, may be aggravated after eating, and can occur in any part of the abdomen, although it more typically is located in the lower abdomen; it may be referred to different areas in abdomen or to the chest or back. Exacerbation of pain by life events or difficult life situations is common. Abdominal discomfort or pain that is continuous or unrelated to defecation or induced by menstruation, urination or physical activity is unlikely to be caused by IBS. [1]
Constipation or Diarrhea: Patients with IBS experiences constipation, diarrhea or alternating constipation and/or diarrhea; typically bowel symptoms are variable and intermittent. The term constipation and diarrhea may reflect a wide variety of different symptoms experiences for different patients. Whenever patient uses these terms, an exploration of their meaning is required. Stool form can be measured objectively and graded by patient or physician; the Bristol stool form/scale is routinely used in clinical trials, and changes in stool form (at the extreme ends of the scale) roughly correlate with colonic transit time.
Bloating and Visible Distention: A feeling of bloating is common in IBS, and its site can be difficult for the patient to localize. Visible abdominal distention is characteristic but less common. Gas can mean excess bloating, belching, flatus, or even reflux symptoms into the patient. Again, it is important that patients are asked to explain the meaning of the terms they are using to describe their symptoms. [2]
Non – colonic Symptoms: They themselves are not diagnostic. Nausea is common and at least one third of patients with IBS have epigastric discomfort or pain (dyspepsia). Extracolonic symptoms including headache, backache, impaired sleep, fatigue, increased urinary frequency or urgency, and dyspareunia are more common in patients with IBS but have no accepted diagnostic value. Comorbid anxiety or depression, and fibromyalgia also are associated with IBS.
Chronicity: For a confident diagnosis of IBS, symptoms should have been present for at least 6 months; IBS may accompany other chronic disorder. For example, IBS is present in one third or more patients with IBD in remission.
Physical Examination
The physical examination in IBS usually is normal, although deep tenderness over the colon may be appreciated. Abdominal wall pain should be excluded clinically by Carnett’s test. [1,2]
Management:
Education and support
IBS tends to be a life – long disorder, and establishment of a strong physician – patient relationship is a key to providing the best clinical care.
It is important to discover why the patient has decided to visit at this time. The reason can vary: new life stressors; exacerbating factors in the diet or change in medication; increased fear of serious disease; and the development of treatable psychiatric comorbidity. In terms of providing optimal reassurance, it is important first to educate the patient and then to actively reassure them.
Diet
The standard of care for IBS typically has been a high fiber diet. Many patients with IBS suspect that food intolerance may be relevant to their symptoms. It is useful to determine the amounts of milk and milk products being consumed to decide whether lactose intolerance testing should be considered. If IBS symptoms persists despite withdrawal of all lactose in diet, indicating that this is the chance overlap of common condition. Excessive fructose can lead to IBS like symptoms that might be relieved by exclusion of this sugar. Reducing fatty food, gas producing food, or caffeine or alcohol also may be helpful in some patients.
Antispasmodics and Anticholinergics
In USA, Anticholinergics (dicyclomin, propanthelin, belladonna, and hyoscyamine) continue to be used commonly for IBS. Overall there was an improvement in pain and IBS global symptoms. [3]
Laxatives
The efficacy of this class of drugs for constipation predominant IBS is uncertain. Osmotic laxatives often are prescribed but can aggravate bloating and pain. Stimulant laxatives are probably safer than has been appreciated, but they often induce abdominal cramping or pain and generally seem unsatisfactory for patients with IBS.
Antidiarrheals
Loperamide is established to be efficacious in controlling diarrhea but this agent does not improve abdominal pain or bloating. Codeine phosphate because of its side effects (dizziness, nausea and sedation) and high risk of inducing dependency should be avoided in IBS. [3]
Antidepressant and Anxiolytics
Miscellaneous Drugs
Three weeks of oral prednisone (30 mg/day) failed to improve post infectious IBS symptoms. Colchicine increases spontaneous bowel movements and decreases colonic transit time, but its role in IBS with constipation is unknown. Octreotide reduces intestinal transit time, secretion and sensations in IBS. [3]
Psychological Treatments
Psychotherapy, hypnotherapy, and cognitive behavioral therapy (CBT) have been proposed to be useful treatment for IBS. Psychological distress appear most likely to have a beneficial response to such intervention, particularly if the symptoms have been of short duration and have waxed and waned. Patients with constant abdominal pain do poorly with psychological treatment. The major advantage of psychological treatment is that despite the initial expense, long term benefits may be cost offsetting.
Alternative Treatments
Many different alternative remedies have been tried by patients but statistical efficacy of all needs to be proved.
Prognosis:
In clinical practice, once a diagnosis of IBS has been made, it usually requires no revision despite prolonged follow up. Usually IBS is a relapsing disorder. The presence of excessive pathological distress or anxiety, as well as a long duration of complaints, tends to indicate a poorer prognosis. [3,4]
Aims and Objectives
Aim
To assess the efficacy of Homoeopathic Medicines in cases of IBS.
Objective
To study utility of Homoeopathy in IBS.
To reduce the:
Frequency
Intensity
Duration
Recurrence Of cases of IBS
Materials and Methods
The study was conducted on patients coming to Author’s OPD. A sample of 30 cases was taken. Diagnosis was mostly done clinically by using Manning’s, Rome I and Rome II criteria. Patients from all ages and both the sexes were studied. The data has been collected by a structured interview session.
Case definition
Irritable Bowel Syndrome is clinically defined as consisting of altered bowel habit, abdominal pain, and the absence of detectable organic pathology
Inclusion Criteria
All cases which fit into Manning’s criteria and Rome’s criteria
Exclusion Criteria
Cases which don’t fit into Manning’s and Rome’s criteria
Cases with symptoms for less than 12 weeks
Cases with abnormalities in lab investigations
Material
All the data was recorded in case format attached in appendix. Cases were analyzed and evaluated and repertorised with Synthesis Repertory RADAR 10.
Follow up chart was maintained to evaluate improvement in each case and is thus data of all cases is maintained.
Administration of Drug
The potency and repetition were strictly individualistic
Medicines were administered orally
Criteria for Assessment
Relief of symptoms
Patient in general
Reduction in duration of attack
Relief from reoccurrence
For an effective evaluation and assessment, disease intensity was graded in every patient based on their presentation observed during case taking. After completion of the study, the post treatment disease scores were compared with the pre treatment disease intensity scores and statistically evaluated.
The evaluation of cases of IBS is based on the disease intensity scores before treatment and after treatment. The cases with intensity scores 0 (after treatment) are considered as IMPROVED and the cases with ‘Same’ or ‘Increased’ intensity scores after treatment are considered as NOT IMPROVED.
Observation and Statistical Analysis
A sample of thirty cases from patients from the author’s OPD was taken for this study. All the thirty cases were followed up for a period of six months. These cases were subjected to statistical study. The following tables reveal the observation and result of this study.
The age of the sample varies from 16 – 65 years. Among this maximum number of cases 9 patients (30%) were noted in the age group of 31-40 years. In the age group of 41-50 and 51 – 60 years 6 (20%) cases. The next incidence of age group is in 21-30 years with 5 patients (16.66%). This is followed by the age group 11- 10 years and 61 years and above with 2 patients (6.66%)
In these thirty cases 10 patients were males with a percentage of 33.33% and 20 patients were females with a percentage of 66.67%. The male and female ratio is 1:2. This again shows the female predominance in cases of IBS.
Surprising finding was that 11 out of 30 (36.66%) are housewives. Out of remaining patients, 9 have sedentary life style because of job. 3 are students and 2 are engineers.
Out of 30 patients 16 (54%) showed predominant diarrhea, 10 (33%) showed predominant constipation and remaining 4 (13%) showed alternate diarrhea and constipation.
To assess the utility of Homoeopathy, scoring was done for the symptoms shown before and after treatment. Paired ‘T’ test was applied.
While considering the totality in cases, the entry point for prescribing totality was either modality, concomitant or sensation.
List of remedies indicated is as follows:
Name of Remedy No. Of cases
Sulphur 3
Nux – V 3
Pulsatilla 3
Sepia 2
Silicea 2
Nat – M 2
Colo 2
Nat – C 1
Thuja 1
Anacardium 1
Ars alb 1
Aloe 1
Arg Nit 1
Mag – C 1
Merc – sol 1
Croton – Tig 1
Bryonia 1
Graphites 1
Gambogia 1
Calc – C 1
Aesculus 1
Gelsemium 1
Podophyllum 1
Lycopodium 1
Antim – C 1
Scores before and after Homoeopathic treatment
X = Score before treatment Y = Score after treatment
Comparison with tabled value
This critical ratio, t, follows a distribution with n-1 degrees of freedom. The table value at 5% level is 2.00 for 29 degree of freedom and the 1% level 2.60. The calculated value is 9.36. It is greater than the table value at 5% and 1% level. This means the probability (P) is greater than the table value. Therefore, the null hypothesis is rejected in this study.
Master Chart
Discussion
Cases of IBS were studied for the effectiveness of Homoeopathy. Even though IBS is a psycho – somatic disease, many times the exact mental cause can’t be elicited as most of these personalities are over anxious. They tend to misguide the intensity of their suffering and cause. It is difficult for budding Homoeopaths to interpret mind or to find out the exact causative factor. Instead physicals seem easy to rely upon.
Physical generals, modalities and concomitants are more dependable and easy to elicit. These symptoms tend to form the symptom complex of patients with IBS.
Prominent Discoveries
Female predominance is known but out of these 20 females 11 were housewife. This again needs further statistical analysis.
Considering age, the youngest was 16 years-old and oldest was 65 years. As proved many times middle age group showed maximum number of patients.
The initial remedy, which was indicated in the first analysis after case-working, improved patients in 80% of cases - proving the utility of this approach with Synthesis Repertory.
In many cases the remedy indicated was confirmed by mental symptoms as well as physical symptoms. E.g. one case remedy was Graphites, it was confirmed with other observations like cracked skin, tendency to weep, etc.
Concomitants gave a great clue in the selection of remedies in 3 cases.
As outlined in all books of gastroenterology, counseling plays an important role. In case number 7 (R. S.), the girl afterwards gave a history of recent disappointment in love. Along with medical treatment, counseling and meditation helped her in accepting the situation.
For very anxious patients yoga also played a great role in relieving stress, bloating and dyspepsia. In some cases yoga relieved constipation as well. But the patient needed to be convinced to follow such therapy.
Exclusion of certain diet food was advised to two patients for few days. After treatment they could eat those same food which used to precipitate the complaints.
The above played an adjuvant role and helped to improve the treatment of patients.
Summary and Conclusion
A total of 30 cases were studied and followed for a minimum of 6 months. The data which was collected was subjected to statistical analysis - ‘t’ test is applied for statistical analysis as n was less than 30.
The statistical analysis proves that Homoeopathy is significantly useful in these 30 cases of IBS. Out of 30 cases 24 cases, or 80%, showed marked improvement in symptoms as well as reduction in duration and frequency of attacks.
Along with the medicine we found that adjuvant therapies - counseling, meditation, yoga and certain dietary restrictions - were effective in the management of patients.
Synthesis is like an ocean of rubrics with its ever increasing number of rubrics and remedy lists. Determining an appropriate rubric is easy as the repertory structure has a Kentian dominance. This repertory is very user friendly and the option of a word index makes it easier for a beginner to get acquainted with the repertory. In addition, comparative remedy analysis helps beginners enhance their knowledge of Materia Medica.
The ultimate aim of all physicians should always be to ease the patient of suffering - quickly, gently and permanently. This aim can be achieved in different ways, and the approach is highly individualized.
For all beginners, Homoeopathy is easy as it is based on observable facts and not the interpretation. Interpretation can differ from person to person but modalities or observable concomitant of tongue or stool can’t be changed. This builds up confidence in budding Homoeopaths to produce good results and when treating the chronic disorders.
In conclusion, this research ends with the following quote:
“No matter what approach you use or what repertory you use, when your understanding of the core of patient is clear, you are bound to reach a similimum.”
Acknowledgement
I, Dr. Parth Aphale, M.D.(Hom.), Faculty, Department of Homoeopathic Pharmacy, Dr. D.Y. Patil Homoeopathic Medical College & Research Centre, Pune (Dr. DYPHMCRC), would like to thank respected Dr. D.B. Sharma, Principal, Dr. DYPHMCRC, Pune for giving me this opportunity to take up this research project and test the efficacy of Homoeopathy in IBS. I would also like to thank Dr.Atul Rajgurav, H.O.D, Department of Homoeopathic Pharmacy for his valuable help in this research work.
Bibliography
Medicine Books
Harrison’s principles of Internal Medicine – 17th edition
Davidson’s principle and practice – 20th edition
Gastrointestinal diseases by Sleisenger and Fordtran – 8th edition
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