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Osteopathic manipulative treatment and nutrition: An alternative approach to the irritable bowel syndrome

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A simple treatment plan for manual therapists is presented based on current evidence-based literature, it is designed to lessen chronic pain and inflammation in the Irritable Bowel Syndrome (IBS). A chronic continuous or intermittent gastrointestinal tract dysfunction, IBS appears due to dysregulation of brain-gut-microbe communication. An overview of its management using Osteopathic Manipulative Treatment (OMT) is described. In IBS OMT focuses on the nervous and circulatory systems, spine, viscera, thoracic and pelvic diaphragms in order to restore homeostatic balance, normalize autonomic activity in the intestine, promote lymphatic flow and address somatic dysfunction. Lymphatic and venous congestion is treated by the Lymphatic Pump Techniques and stimulation of Chapman’s Reflex Points. The food itself, food allergies and intolerance could contribute to symptom onset or even cause IBS. Furthermore the “microbiota” greatly impacts on the bi-directional brain-gut axis communication. This paper also provides appropriate dietary modifications for patients with IBS.
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Vol.5, No.6A2, 87-93 (2013) Health
doi:10.4236/health.2013.56A2013
Osteopathic manipulative treatment and nutrition: An
alternative approach to the irritable bowel syndrome
Luca Collebrusco1, Rita Lombardini2
1Rehabilitation Unit, National Health Service of Umbria, Perugia, Italy
2Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy; rlomba@unipg.it
Received 12 February 2013; revised 12 March 2013; accepted 10 April 2013
Copyright © 2013 Luca Collebrusco, Rita Lombardini. This is an open access article distributed under the Creative Commons Attri-
bution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
ABSTRACT
A simple treatment plan for manual therapists is
presented based on current evidence-based lit-
erature, it is designed to lessen chronic pain and
inflammation in the Irritable Bowel Syndrome
(IBS). A chronic continuous or intermittent gas-
trointestinal tract dysfunction, IBS appears due
to dysregulation of brain-gut-microbe commu-
nication. An overview of its management using
Osteopathic Manipulative Treatment (OMT) is
described. In IBS OMT focuses on the nervous
and circulatory systems, spine, viscera, thoracic
and pelvic diaphragms in order to restore ho-
meostatic balance, normalize autonomic activity
in the intestine, promote lymphatic flow and ad-
dress somatic dysfunction. Lymphatic and ve-
nous congestion is treated by the Lymphatic
Pump Techniques and stimulation of Chapman’s
Reflex Points. The food itself, food allergies and
intolerance could contribute to symptom onset
or even cause IBS. Furthermore the “microbi-
ota” greatly impacts on the bi-directional brain-
gut axis communication. This paper also pro-
vides appropriate dietary modifications for pa-
tients with IBS.
Keywords: Irritable Bowel Syndrome; Chronic
Visceral Pain; Osteopathic Manipulative Treatment;
Nutrition
1. INTRODUCTION
The present paper defines a simple treatment plan for
manual therapists, which is designed to reduce chronic
pain and inflammation in the Irritable Bowel Syndrome
(IBS). We provide an overview of its management using
Osteopathic Manipulative Treatment (OMT), dietary
modification and nutritional supplementation, according
to the current evidence-based literature.
A chronic continuous or intermittent gastrointestinal
tract (GIT) dysfunction, IBS was defined by Rome
Committee III on the basis of abdominal discomfort or
pain (Table 1) [1]. IBS is found in twice as many females
as males in 10% - 15% of the population, affecting all
adult age groups up to 50 [2]. Although its etiology and
pathophysiology remain uncertain, IBS appears due to
“brain-gut axis” dysregulation. The central nervous sys-
tem communicates with the gut by mediating the sympa-
thetic and parasympathetic autonomic nervous systems
(SANS and PANS) which control enteric nervous system
(ENS) function. Alterations in SANS, PANS and ENS
were described in IBS patients [3,4]. Compared with
normal subjects, they have an increased vagal response
to rectal distension, decreased vagal response to sigmoid
distension, a blunted adrenocorticotropic hormone re-
sponse and lower plasma cortisol levels, suggesting ab-
normalities in the central control mechanisms that are
involved in autonomic and neuroendocrinal response to
visceral stimulation [5]. Central mechanisms include
anxiety, depression and somatisation; peripheral dys-
function is characterized by gut motility and secretion
changes and visceral hypersensitivity [6,7]. IBS is as-
sociated with structural changes in grey matter density
involving key areas in attention, emotion regulation, pain
inhibition and visceral information processing [8]. Pro-
inflammatory cytokines such as IL-6, TNF-α and IL-8,
Table 1. Rome III criteria.
At least 3 months, with onset at least 6 months previously of
recurrent abdominal pain or discomfort* associated with 2
or more of the following:
Improvement with defecation; and/or;
Onset associated with a change in frequency of stool; and/or;
Onset associated with a change in form (appearance) of stool.
*Discomfort means an uncomfortable sensation not described as pain.
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L. Collebrusco, R. Lombardini / Health 5 (2013) 87-93
88
mast cells and pro-inflammatory polyunsatured fatty acid
metabolites were increased [9-11]. Other potential causes
of IBS are diet and enteric flora abnormalities leading to
low-grade inflammation/immune activation [12].
Symptoms are diarrhea-predominant (IBS-D), consti-
pation-predominant (IBS-C), or alternating diarrhea and
constipation (IBS-DC) [13]. Other symptoms are bloat-
ing, early satiety, nausea, heartburn, feeling of incom-
plete emptying on defecation, borborygmi and flatulence.
Migraine, back pain, dyspareunia and muscle pain indi-
cate a central hyperalgesic mechanism [14]. Abdominal
pain (Figure 1) is associated with significant morbidity,
including depression, poor quality of life, and even in-
ability to work. Patients with IBS were more likely than
non-IBS sufferers to complain of problems relating to
diet and eating out, concentration, long journeys, physi-
cal appearance and personal relationships. They had
more sick days off work with considerable social and
economic costs [15].
2. OMT
Over a century ago Andrew Taylor Still devised a sys-
tem of disease prevention and treatment through me-
chanical manipulation known as OMT. He identified the
musculoskeletal system as a key to health, hypothesizing
that every illness was the result of an anatomical disorder
associated with physiological discord, termed “Somatic
Dysfunction” (SD). SD is “impaired or altered function
of related components of the somatic framework; skeletal,
arthroidal, myofascial and related vascular, lymphatic
and neural elements” [16]. It contributes to the effect of
organic pathology and is catalogued as a disease of
musculoskeletal system (ICD-9, code 739). Primary SD
is completely reversible when correctly diagnosed and
treated with OMT. Secondary SD also responds to OMT
but will recur unless the primary pathology is identified
and treated [17]. SD is diagnosed by palpation proce-
dures (“A.R.T.T.” examination) [18] (Figure 2).
OMT consists of a range of direct, indirect, combined,
fluid and reflex-based manual techniques (Figure 3) that
are applied specifically to a joint or non-specifically to a
body area [19]. Direct techniques apply thrust, impulse,
muscle contraction, fascial loading, or passive range of
motion. They engage the restrictive barrier and use an
activating force to achieve the tissue response and cor-
rect the SD. Indirect, fluid, balancing, or reflex-based
techniques do not engage the restrictive barrier. They use
fascial massage, fascial and soft tissue loading or unload-
ing, hydraulic pressures, respiration phases and cranial or
postural adjustments [20].
OMT for IBS
In IBS OMT focuses on the nervous and circulatory
Figure 1. Areas of pain associated with
IBS (modified from Stone 2007).
Figure 2. OMT palpation procedures or the ARTT technique.
Figure 3. Overview of OMT techniques.
systems, spine, viscera, thoracic and pelvic diaphragms
in order to restore homeostatic balance, normalize auto-
nomic activity in the intestine, promote lymphatic flow
Copyright © 2013 SciRes. Openly accessible at http://www.scirp.org/journal/health/
L. Collebrusco, R. Lombardini / Health 5 (2013) 87-93 89
and address SD. The first step assesses the pattern of
signs and symptoms. Safety is paramount. If alarm sig-
nals, or “Red Flags” [21,22], are present the patient
should be referred to a physician (Table 2).
Sagittal Plane Symmetry and the Common Compen-
satory Pattern (CCP) are observed in the postural exami-
nation [23,24]. The therapist then starts palpation using
A.R.T.T. diagnostic criteria to search for SD. Attention
focuses on sympathetic innervation from the lower tho-
racic to the upper lumbar spinal segments (T4-L2) via
the collateral sympathetic ganglia (celiac, upper and
lower mesenteric). Visceral afferent stimulation activates
the hypothalamus pituitary adrenal axis and the auto-
nomic nervous system, involving the release of neuro-
transmitters and hormones such as corticotropin-releas-
ing factor which may play a role in modulating emotions
[25]. Moving to parasympathetic innervation the thera-
pist concentrates on the vagus nerve, which innervates
the small intestine and colon up to the splenic flexure.
Treatment of the upper cervical spine, cranial base and
general sub-occipital area releases tension on the vagus
nerve, as it passes through the jugular foramen. Assess-
ment continues with the mid-cervicals (C3, 4, 5), where
the phrenic nerve arises to supply the thoracic diaphragm
(Figure 4). Pelvic and sacroiliac joints should be treated
as they may affect the pelvic splanchnic nerves (S2, 3, 4)
which innervate the descending and sigmoid colon tracts
[26,27].
Table 2. Red Flags for IBS.
Ulcerative Colitis and Crohn’s Disease
Diarrhea
Constipation
Fever
Abdominal pain
Rectal bleeding
Night sweats
Decreased appetite, nausea, weight loss
Skin lesions
Uveitis (inflammation of the eye)
Arthritis
Migratory arthralgias
Hip pain (iliopsoas abscess)
Colorectal Cancer
Rectal bleeding, haemorrhoids
Abdominal, pelvic, back, or sacral pain
Back pain that radiates down the legs
Changes in bowel patterns
Advanced Stages
Constipation progressing to obstipation
Diarrhea with much mucus
Nausea, vomiting
Abdominal distention
Weight loss
Fatigue and dyspnea
Figure 4. Combination of direct and indirect techniques.
In IBS, lymphatic and venous congestion should be
treated by the lymphatic pump techniques (Figure 5) and
stimulation of chapman’s reflex points (Figure 6). They
increase lymph flow and improve blood circulation thus
facilitating healing and enhancing the efficacy of any
medication [28,29].
The OMT plan for IBS is shown in Figure 7.
3. NUTRITION
Hippocrates (460-357 BC) was the first to suggest that
“He who does not know food, cannot understand the
diseases of man”. A. T. Still believed the body made its
own remedies against disease and other toxic conditions
when it was structurally normal and had favorable envi-
ronmental conditions and adequate nutrition. In the mod-
ern diet increased consumption of high-density, low-
quality foods, particularly when rich in refined starches,
sugar, and lipids and poor in natural antioxidants and
fibre, promote systemic inflammation which underlies
chronic pain and several degenerative diseases [30,31].
The role of diet in IBS remains to be elucidated. Food
could contribute to symptom onset or even cause IBS
itself [32]. IBS symptoms are often exacerbated immedi-
ately after eating because of increased intraluminal vol-
umes or motor activity, via excessive activation of vagal
mechano- and chemo-receptors [5]. Food allergy (im-
mune-mediated) or intolerance (not immune-mediated)
could play a role in IBS [33]. Food antigens may result
in low-grade mucosal inflammation and immune system
activation through mast cell activation and degranulation,
which in turn secrete several chemical messengers (e.g.
transmitters, cytokines) that mediate bowel sensor-motor
dysfunction [34]. Finally, some foods may alter gut mi-
crobes or “microbiota” qualitatively, thus increasing gas
production. Transit of exogenous gas loads was impaired
in patients with IBS and gas retention reproduced their
bloating symptoms [35]. Proliferation of certain species
that produce short-chain fatty acids and deconjugate bile
acids more avidly could lead to clinically significant
changes in water and electrolyte transport in the colon
and affect colonic motility and/or sensitivity [32].
Furthermore, the microbiota greatly impacts on the
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L. Collebrusco, R. Lombardini / Health 5 (2013) 87-93
90
Figure 5. The lymphatic pump techniques.
Figure 6. Stimulation of Chapman’s reflex points.
bi-directional brain-gut axis communication [36]. Inno-
vative research suggested microbiota affected the vagus
nerve and modulated systemic levels of tryptophan, a
serotonin precursor [37]. Together with the finding that
dietary carbohydrates facilitated tryptophan entry into
the brain, these data lead to the hypothesis that specific
modulation of enteric microbiota and dietary habit is a
useful strategy for GIT stress-related disorders, like IBS
[36,38].
Nutrition for IBS
Due to fear of symptom exacerbation patients with
Care should be exercised milk, wheat and eggs which are
often reported to trigger symptoms and over salycylate or
amine-rich foods as they worsen symptoms [39]. Fatty
food should be avoided since lipids strongly stimulate
motor and sensory responses which are often increased
in IBS patients [40]. Patients, particularly those with
IBS-D, should be particularly careful with carbohy-
drates like lactose, fructose and sorbitol as they are mal-
absorbed.
Fibre supplements should be introduced into the diet
very gradually so as to minimize bloating, particularly in
patients with IBS-C [39]. Patients should receive more
soluble than insoluble fibre [41].
Probiotic supplements aid intestinal pain management
by increasing mucosal anti-inflammatory cytokines while
reducing the pro-inflammatory, thus enhancing the mu-
cosal barrier function [42-45].
A carbohydrate-rich, protein-poor meal increased brain
concentration of tryptophan, and increased serotonin
synthesis [46,47]. Given the importance of serotonin as a
neurotransmitter in the ENS, one might speculate that a
carbohydrate-rich diet might improve mood, alleviating
anxiety, depression and somatisation.
Table 3 summarizes an appropriate nutritional ap-
proach for IBS patients.
4. DISCUSSION
In diseases like IBS which link the somatic and vis-
ceral systems, the gastrointestinal barrier impairment in-
creases the risk of developing infectious, inflammatory
and immune-mediated disorders. Recent research has
focused on the role of the intestine in health maintenance
and the “gut health” approach is providing a new strategy
in preventive medicine [48]. IBS, however, often goes
untreated, as approximately 70% of patients do not seek
medical care and in many countries, including the US,
prescription medication insurance coverage for IBS is
decreasing [49]. Furthermore traditional medication of-
fers marginal efficacy with only 7% - 15% gains over
placebo, and safety concerns are growing [43].
Table 3. Dietary recommendations.
AVOID:
Large meals,Alcoholic beverages, Caffeinated drinks, Carbonated
drinks, Fatty food, Hot spices
CAUTION:
Eggs, Wheat products, High-salicylate foods: nuts, corn, wine,
tomato, seasoned meat, ecc.; High-amine foods: chocolate,
banana, avocado, spinach, ecc.; High-lactose-content products:
milk, ice cream, yogurt; High-fructose-content products: honey,
date, orange, apple, pear, corn syrup; Sorbitol-content products:
artificial sweeteners, stone fruits; Gas-producing foods:
beans, peas, broccoli, cabbage, bran.
LOW INCREASE:
Carbohydrate-rich foods: buckwheat, oats, etc.; Soluble fibre: oat
bran, soy, barley, rice, currants, etc.
ADD:
Soluble fiber: psyllium or Ispaghula; Probiotic combinations of
Lactobacilli, Bifidobacteria and Streptococci
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L. Collebrusco, R. Lombardini / Health 5 (2013) 87-93
Copyright © 2013 SciRes. http://www.scirp.org/journal/health/
91
Figure 7. OMT plan for IBS.
In patients with IBS, the introduction of “direct ac-
cess” (which allows patients to bypass the general practi-
tioner in favour of a physical or manual therapist) is an-
other major factor underlying their desire for more holis-
tic and “natural” treatment options like OMT, dietary
modification and nutritional supplementation. OMT pro-
vides the patient with relaxation, normalized autonomic
control mechanisms, congestion and symptom relief, and
better control over his/her reactions to stress. The dietary
modifications proposed in this paper may remove trig-
gers of IBS while the nutritional supplements help
re-balance gut health.
Openly accessible at
5. CONCLUSION
Therapists now need to take a more holistic view of
patients with IBS and provide a more comprehensive
treatment model. Combining OMT with appropriate nu-
trition appears to be an optimal approach and might rep-
resent a promising strategy. Although this therapeutic
plan may not be ideal for everyone, the majority of pa-
tients could well benefit from its use.
6. ACKNOWLEDGEMENTS
The authors would like to thank Dr Geraldine Anne Boyd for editing
this paper.
REFERENCES
[1] Drossman, D.A., Corazziari, E., Delvaux, M., Spiller, R.,
Talley, N.J., Thompson, W.G., et al. (2006) Rome III: The
functional gastrointestinal disorders. 3rd Edition, Degnon
Associates, McLean, 885-893.
[2] El-Salhy, M. (2012) Irritable bowel syndrome: Diagnosis
and pathogenesis. World Journal of Gastroenterology, 7,
5151-5163.
[3] Kennedy, P.J., Clarke, G., Quigley, E.M., Groeger, J.A.,
Dinan, T.G. and Cryan, J.F. (2012) Gut memories: To-
wards a cognitive neurobiology of irritable bowel syn-
drome. Neuroscience and Biobehavioral Reviews, 36,
310-340. doi:10.1016/j.neubiorev.2011.07.001
[4] Waring, W.S., Chui, M., Japp, A., Nicol, E.F. and Ford,
M.J. (2004) Autonomic cardiovascular responses are im-
paired in women with irritable bowel syndrome. Journal
of Clinical Gastroenterology, 38, 658-663.
doi:10.1097/01.mcg.0000135362.35665.49
[5] Schmulson, M.J. (2001) Brain-gut interaction in irritable
bowel syndrome: New findings of a multicomponent dis-
ease model. The Israel Medical Association Journal, 3,
104-110.
[6] Barbara, G., De Giorgio, R., Stanghellini, V., Cremon, C.,
Salvioli, B. and Corinaldesi, R. (2004) New pathophysi-
ological mechanisms in irritable bowel syndrome. Ali-
mentary Pharmacology and Therapeutics, 20, 1-9.
doi :1 0. 1111/ j. 1365-2036.2004.02036.x
[7] Karantanos, T., Markoutsaki, T., Gazuoli, M., Anagnou,
N.P. and Karamanolis, D.G. (2010) Current insights into
pathophysiology of Irritable Bowel Syndrome. Gut Path-
ogens, 2, 1-8. doi:10.1186/1757-4749-2-3
[8] Seminowicz, D.A., Labus, J.S., Bueller, J.A., Tillisch, K.,
Naliboff, B.D., Bushnell, M.C., et al. (2010) Regional
grey matter density changes in brains of patients with ir-
ritable bowel syndrome. Gastroenterology, 139, 48-57.
doi:10.1053/j.gastro.2010.03.049
L. Collebrusco, R. Lombardini / Health 5 (2013) 87-93
92
[9] Bashashati, M., Rezaei, N., Andrews, CN., Chen, CQ.,
Daryani, N.E., Sharkey, K.A., et al. (2012) Cytokines and
irritable bowel syndrome: Where do we stand? Cytokine,
57, 201-209. doi:10.1016/j.cyto.2011.11.019
[10] Ford, A.C. and Talley, N.J. (2011) Mucosal inflammation
as a potential etiological factor in irritable bowel syn-
drome: A systematic review. Journal of Gastroenterology,
46, 421-431. doi:10.1007/s00535-011-0379-9
[11] Clarke, G., Fitzgerald, P., Hennessy, A.A., Cassidy, E.M.,
Quigley, E.M.M., Ross, P., et al. (2010) Marked eleva-
tions in pro-inflammatory polyunsaturated fatty acid me-
tabolites in females with irritable bowel syndrome. Jour-
nal of Lipid Research, 51, 1186-1192.
doi:10.1194/jlr.P000695
[12] Lee, B.J. and Bak, Y.T. (2011) Irritable bowel syndrome,
gut microbiota and probiotics. Journal of Neurogastroen-
terology and Motility, 17, 252-266.
doi:10.5056/jnm.2011.17.3.252
[13] Elsenbruch, S. (2011) Abdominal pain in Irritable Bowel
Syndrome: A review of putative psychological, neural and
neuro-immune mechanism. Brain, Behaviour, and Immu-
nity, 25, 386-394. doi:10.1016/j.bbi.2010.11.010
[14] Mayer, E.A. and Gebhart, G.F. (1994) Basic and clinical
aspects of visceral hyperalgia. Gastroenterology, 107,
271-293.
[15] Hungin, A.P.S., Whorwell, P.J., Tack, J. and Mearin, F.
(2003) The prevalence, patterns and impact of irritable
bowel syndrome: an international survey of 40,000 sub-
jects. Alimentary Pharmacology and Therapeutics, 17,
643-650. doi:10.1046/j.1365-2036.2003.01456.x
[16] Glover, J.C. (2006) Educational Council on Osteopathic
Principles. Glossary of osteopathic terminology. Ameri-
can Association of Colleges of Osteopathic Medicine,
Chicago.
http://www.do-online.org/pdf/sir_collegegloss.pdf
[17] Nelson, K.E. (2007) Diagnosing somatic dysfunction. In:
Nelson, K.E. and Glonek, T., Eds., Somatic Dysfunction
in Osteopathic Family Medicine, Lippincott Williams &
Wilkins, 12-13.
[18] Chaitow, L. (2012) The ARTT of palpation? Journal of
Bodywork & Movement Therapies, 16, 129-131.
doi:10.1016/j.jbmt.2012.01.018
[19] DiGiovanna, E.L. (2005) Goals, classifications, and mod-
els of osteopathic manipulation. In: DiGiovanna, E.L.,
Schiowitz, S. and Dowling, D.J., Eds., An Osteopathic
Approach to Diagnosis and Treatmen, 3rd Edition, Lip-
pincott Williams & Wilkins, 77-79.
[20] SOPE (2010) The scope of osteopathic practice in Europe.
European Federation of Osteopaths editors, Brussels.
[21] APTA (2011) Today’s physical therapist: A comprehen-
sive review of a 21st-Century health care profession.
American Physical Therapy Association
[22] Goodman, C.C. and Snyder, T.K. (2007) Differential
diagnosis for physical therapists. Screening for referral.
4th Edition, Elsevier, Mosby Saunders, 393-395.
[23] Schiowitz, S. and Dowling, D.J. (2005) Structural Exa-
mination and Documentation. In: DiGiovanna, E.L.,
Schiowitz, S. and Dowling, D.J., Eds., An Osteopathic
Approach to Diagnosis and Treatment, 3rd Edition, Lip-
pincott Williams & Wilkins, 53-63.
[24] Parsons, J. and Marcer, N. (2005) Irritable bowel syn-
drome. In: Osteopathy—Models for diagnosis, treatment
and practice, Elsevier, Churchill Livingstone, 265-269.
[25] O’Malley, D., Quigley, E.M.M., Dinan, T.G. and Cryan,
J.F. (2011) Do interactions between stress and immune
responses lead to symptom exacerbations in irritable
bowel syndrome? Brain, Behavior, and Immunity, 25,
1333-1341. doi:10.1016/j.bbi.2011.04.009
[26] Stone, C.A. (2007) Visceral and obstetric osteopathy.
Elsevier, Churchill Livingstone, 111-149.
[27] DeStefano, L. (2011) Greenman’s principles of manual
medicine. 4th Edition, Lippincott Williams & Wilkins.
[28] Capobianco, J.D. (2005) Chapman's Reflex Points. In:
DiGiovanna, E.L., Schiowitz, S. and Dowling, D.J. Ed.,
An Osteopathic Approach to Diagnosis and Treatment.
3rd. Lippincott Williams & Wilkins, 113-117.
[29] Hodge, L.M. and Downey, H.F. (2011) Lymphatic pump
treatment enhances the lymphatic and immune systems.
Experimental Biology and Medicine, 236, 1109-1115.
doi:10.1258/ebm.2011.011057
[30] Seaman, D.R. (2002) The diet-induced proinflammatory
state: A cause of chronic pain and other degenerative dis-
eases? Journal of Manipulative and Physiological Thera-
peutics, 25, 168-79. doi:10.1067/mmt.2002.122324
[31] Galland, L. (2010) Diet and inflammation. Nutrition in
Clinical Practice, 25, 634-640.
doi:10.1177/0884533610385703
[32] Morcos, A., Dinan, T. and Quigley, E.M.M. (2009) Irrita-
ble bowel syndrome: Role of food in pathogenesis and
management. Journal of Digestive Diseases, 10, 237-246.
doi :1 0. 1111/ j. 1751-2980.2009.00392.x
[33] Katiraei, P. and Bultron, G. (2011) Need for a compre-
hensive medical approach to the neuroimmuno-gastroen-
terology of irritable bowel syndrome. World Journal of
Gastroenterology, 17, 2791-2800.
[34] Park, M.I. and Camilleri, M. (2006) Is there a role of food
allergy in irritable bowel syndrome and functional dys-
pepsia? A systematic review. Neurogastroenterology and
Motility, 18, 595-607.
doi :1 0. 1111/ j. 1365-2982.2005.00745.x
[35] Agrawal, A. and Whorwell, P.J. (2008) Review article:
Abdominal bloating and distension in functional gastro-
intestinal disorders—Epidemiology and exploration of
possible mechanisms. Alimentary Pharmacology & The-
rapeutics, 27, 2-10.
doi :1 0. 1111/ j. 1365-2036.2007.03549.x
[36] Cryan, J.F. and O’Mahony, S.M. (2011) The microbiome-
gut-brain axis: From bowel to behavior. Neurogastroen-
terology and Motility, 23, 187-192.
doi :1 0. 1111/ j. 1365-2982.2010.01664.x
[37] Grenham, S., Clarke, G., Cryan, J.F. and Dinan, T.G.
(2011) Brain-gut-microbe communication in health and
disease. Frontiers in Physiology, 2, 94.
doi:10.3389/fphys.2011.00094
[38] Fernstrom, J.D. and Wurtman, R.J. (1971) Brain sero-
Copyright © 2013 SciRes. Openly accessible at http://www.scirp.org/journal/health/
L. Collebrusco, R. Lombardini / Health 5 (2013) 87-93
Copyright © 2013 SciRes. http://www.scirp.org/journal/health/Openly accessible at
93
tonin content: Increase following ingestion of carbohy-
drate diet. Science, 174, 1023-1025.
doi:10.1126/science.174.4013.1023
[39] Cabré, E. (2011) Clinical Nutrition University: Nutrition
in the prevention and management of irritable bowel syn-
drome, constipation and diverticulosis. The European
e-Journal of Clinical Nutrition and Metabolism, 6, e85-
e95.
[40] Simren, M., Abrahanmasson, H. and Bjornsson, E.S.
(2007) Lipid induced colonic hypersensitivity in irritable
bowel syndrome: The role of bowel habits, sex and psy-
chological factors. Clinical Gastroenterology and Hepa-
tology, 5, 201-208. doi:10.1016/j.cgh.2006.09.032
[41] Bijkerk, C.J., de Wit, N.J., Muris, J.W.M., Whorwell, P.J.,
Knottnerus, J.A. and Hoes, A.W. (2009) Soluble or in-
soluble fibre in irritable bowel syndrome in primary care?
Randomised placebo controlled trial. British Medical
Journal, 339, b3154. doi:10.1136/bmj.b3154
[42] Brenner, D.M., Moeller, M.J., Chey, W.D., Schoenfeld,
P.S. (2009) The utility of probiotics in the treatment of ir-
ritable bowel syndrome: A systematic review. American
Journal of Gastroenterology, 104, 1033-1049.
doi:10.1038/ajg.2009.25
[43] Chey, W.D., Maneerattaporn, M. and Saad, R. (2011)
Pharmacologic and complementary and alternative medi-
cine therapies for Irritable Bowel Syndrome. Gut and
Liver, 5, 253-266.
[44] O’Mahony, L., Mccarthy, J., Kelly, P., Hurley, G., Luo, F.,
Chen, K., et al. (2005) Lactobacillus and bifidobacterium
in irritable bowel syndrome: Symptom responses and re-
lationship to cytokine profiles. Gastroenterology, 128,
541-551. doi:10.1053/j.gastro.2004.11.050
[45] Ohland, C.L. and MacNaughton, W.K. (2010) Probiotic
bacteria and intestinal epithelial barrier function. Ameri-
can Journal of Physiology-Gastrointestinal and Liver
Physiology, 298, G807-G819.
doi:10.1152/ajpgi.00243.2009
[46] Lyons, P.M. and Truswell, A.S. (1988) Serotonin precur-
sor influenced by type of carbohydrate meal in healthy
adults. American Journal of Clinical Nutrition, 47, 433-
439.
[47] Wurtman, R.J., Wur tm an , J.J., Regan, M.M., McDermott,
J.M., Tsay, R.H. and Breu, J.J. (2003) Effects of normal
meals rich in carbohydrates or proteins on plasma tryp-
tophan and tyrosine ratios. American Journal of Clinical
Nutrition, 77, 128-132.
[48] Bischoff, S.C. (2011) “Gut health”: A new objective in
medicine? BMC Medicine, 9, 24.
doi:10.1186/1741-7015-9-24
[49] Drossman, D.A., Camilleri, M., Mayer, E.A. and White-
head, W.E. (2002) AGA technical review on irritable
bowel syndrome. Gastroenterology, 123, 2108-2131
doi:10.1053/gast.2002.37095
[50] Maitland, G.D., Hengeveld, E., English, K. and Banks, K.
(2005) Maitland’s vertebral manipulation. 7th Edition,
Butterworth Heinemann, Oxford.
... GERD is the most common gastrointestinal diagnosis recorded during visits to outpatient clinics [12]. Although not considered a severe illness [26], it is one of the most common disorders of the gastrointestinal system [27]. ...
... Other well controlled studies evaluating new therapeutic options, to be used either alone or in association with well-established methods of treatment for GERD, are necessary [34]. The OMT provides the patient with relaxation, normalized autonomic control mechanisms, congestion and symptom relief, and better control over his/her reactions to stress [12]. ...
... reflex-based techniques do not engage the restrictive barrier. They use fascial massage, fascial and soft tissue loading or unloading, hydraulic pressures, respiration phases and cranial or postural adjustments[11] [12]. ...
... Apply a slight push towards the pubic symphysisto the visceral package, and, in accordance with the breath, listen to the tissue response until is possible to feel its return. Repeat the maneuver 2 -3 times, in order to reduce tissue's tension (Figure 7), [17] [22] [23]. Health ...
... Since ostheopatic philosophy and practice is based on the body's innate ability to self-regulate, we believe that SD can alter muscle tone, generate a contracture and modify the elasticity/compliance of soft tissues and interfere with physiological and mental processes leading to emotional changes [23]. ...
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... Apply a slight push towards the pubic symphysisto the visceral package, and, in accordance with the breath, listen to the tissue response until is possible to feel its return. Repeat the maneuver 2 -3 times, in order to reduce tissue's tension (Figure 7), [17] [22] [23]. Health ...
... Since ostheopatic philosophy and practice is based on the body's innate ability to self-regulate, we believe that SD can alter muscle tone, generate a contracture and modify the elasticity/compliance of soft tissues and interfere with physiological and mental processes leading to emotional changes [23]. ...
... Other well controlled studies evaluating new therapeutic options, to be used either alone or in association with well-established methods of treatment for PTSD, are necessary. The OMT provides the patient with relaxation, normalized autonomic control mechanisms, congestion and symptom relief, and better control over his/her reactions to stress [12] [31]. ...
... When performing this positioning, allow the ASIS to rise a few inches from the bed. The corrective action consists in performing a HVLA thrust with the hand resting on the ASIS, in a low behind direction [5] [6] [22] [24] (Figure 21). ...
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... The patellar pain syndrome (PFPS) seems to be associated with functional alterations hip, ankle, foot [18]. For the front quadrant: it's possible to detect an association between anterior visceral pain and lower back pain, although there are very few studies investigating the mechanisms [7] [21]- [24]. These three quadrants through the RI model might make more complete the functional evaluation of the symptoms in daily practice, so we reported three case reports, each related to a quadrant (Figure 1). ...
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Aim : To determine the prevalence, symptom pattern and impact of the irritable bowel syndrome, across eight European countries, using a standardized methodology. Methods : A community survey of 41 984 individuals was performed using quota sampling and random digit telephone dialling to identify those with diagnosed irritable bowel syndrome or those meeting diagnostic criteria, followed by in-depth interviews. Results : The overall prevalence was 11.5% (6.2–12%); 9.6% had current symptoms, 4.8% had been formally diagnosed and a further 2.9%, 4.2% and 6.5% met the Rome II, Rome I or Manning criteria, respectively. Bowel habit classification varied by criteria: 63% had an ‘alternating’ bowel habit by Rome II vs. 21% by self-report. On average, 69% reported symptoms lasting for 1 h, twice daily, for 7 days a month. Irritable bowel syndrome sufferers reported more peptic ulcer (13% vs. 6%), reflux (21% vs. 7%) and appendectomy (17% vs. 11%), but not hysterectomy, cholecystectomy or bladder procedures. Ninety per cent had consulted in primary care and 17% in hospital; 69% had used medication. Irritable bowel syndrome substantially interfered with lifestyle and caused absenteeism. Conclusions : Irritable bowel syndrome is common with major effects on lifestyle and health care. The majority of cases are undiagnosed and the prevalence varies strikingly between countries. Diagnostic criteria are associated with varying prevalences and bowel habit sub-types. This limits their utility in clinical practice and the transferability of research findings using them.