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Constipation-predominant IBS
Irritable bowel syndrome (IBS) is
a common disorder of the intestines where patients suffer
with symptoms such as cramping abdominal pain, bloating,
flatulence and change in bowel habit - all suggestive
of a chronic bowel flora infection (see The Unhealthy
Human Bowel Flora). Those with constipation-predominant
IBS (difficult or infrequent bowel movements) typically
suffer bloating especially after meals, abdominal pains
at times, tiredness, nausea, gas, reflux and in some situations
headaches. The problem is known not to be caused by lack
of fibre in the diet, inactivity or lack of water intake.
However, many lay-people will advise the suffering patient
to increase exercise levels and to drink more water in
spite of the fact that this rarely helps. In those with
mild constipation, increase of fibre intake can improve
some symptoms, the fibre acting as a drug, but can worsen
symptoms in others, particularly aggravating bloating.
From accumulating evidence it is most likely that constipation
is acquired as a bacterial infection of the bowel flora
with the most likely culprit being a clostridium. The
reasoning behind this takes into account the fact that
constipation is a chronic, often hospital-acquired problem,
eg. 10% of patients after a hysterectomy,14,
15
that improves significantly with the use of anti-clostridial
agents such as vancomycin,16,
17
and can be reversed to normality after removing the infected
constipated flora and replacement with an HPI.18,
19
The PTRC is not aiming to treat mild or moderate forms
of constipation but rather focuses on those patients in
whom currently available standard therapy such as fibre,
paraffin oil, motility stimulants, and other measures
have failed to give the patient adequate relief. Several
laxatives cause the bowel to become 'black' called pseudomelanosis
and patients can develop insensitivity or become resistant
to these medications over time. Hence, HPI offers a therapy
of last resort to patients where other therapies for constipation
have been ineffective or where symptoms continue in spite
of treatment.
On the basis that constipation is
an infection of the bowel flora with a 'yet-to-be-described'
clostridial bacterium, which also appears to have spores,
a course of vancomycin can dramatically improve the
constipation 16, 17
but is unable to cure the infection except on rare occasions.17
HPIs can be carried out in several ways. Most commonly
a short course of antibiotics is given to reduce the
bacterial load in the bowel and the mucosal surfaces
of the bowel, then the flora is removed by a lavage
solution consumed by the patient similar to that carried
out prior to colonoscopy. The bowel flora is then replaced
by a series of enemas so implanting new bacteria to
eradicate the presumed clostridial spores by the incoming
flora - which is known to eradicate C. difficile spores.6,
7
This treatment has major advantages over laxative therapies
because it can be curative and also alleviate other
motor, fermentative and peristalsis abnormalities such
as slow gastric emptying, reflux, bloating, nausea,
dysphagia and in some patients, chronic tiredness.
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