Homeopathy & Irritable Bowel Syndrome (v. II)
Homeopathy & Irritable Bowel Syndrome (v. II)
Stress restricts recovery and increases harmful commensal intestinal bacteria
Homeopathy, with its potential to address mental, emotional and physical symptoms concurrently, is an increasingly popular treatment option for people suffering irritable bowel syndrome, a complex multi-symptomatic disorder requiring interdisciplinary, gastroenterological and psychotherapeutic, treatments. Observational studies of homeopathy in chronic disease are promising but its role in irritable bowel syndrome is less clear, with two systematic reviews unable to confirm or deny its efficacy.
Irritable bowel syndrome (IBS) is a chronic disease which significantly reduces quality of life (QOL)(1) and usual medical diagnosis for unexplained gastrointestinal symptoms. With global prevalence estimated at 4.1%(2) IBS incurs significant health care costs(3) and is the most common functional gastrointestinal disorder.
Although a personalized approach using pharmacological, dietary and psychologic interventions is recommended,(4) reduced QOL, significant disability, and impaired workforce productivity(5) leaves many IBS patients dissatisfied with their medical care(6) necessitating continued clinical efficacy, safety and cost-effectiveness studies for approved and non-approved IBS treatments.(7)
Pathophysiology of IBS
IBS typically presents with abdominal pain and accompanying stool changes. There are four subtypes diagnosed by Rome IV criteria:(8)
IBS-C constipation predominant.
IBS-D diarrhoea predominant.
IBS-M alternating diarrhoea and constipation.
IBS-U unspecified, having variable symptoms.
The pathology of IBS is not well understood but includes altered gastrointestinal motility, (9) increased intestinal permeability,(10) visceral hypersensitivity, and low-grade inflammation.(11)
Pathogenesis of gastrointestinal infection has been identified(12) in 5% to 32% of cases,(13) associated with small intestinal bacterial overgrowth (SIBO) in up to 78% of diagnoses,(14) and fungal dysbiosis.(15) Dysbiotic commensal bacterial communities are implicated(16) with somatization,(17,18) and differ between subtypes.(19)
Altered faecal and mucosal-associated microbial composition are connected to(19-24) and essential in understanding individual IBS symptom pictures.(25) Many medical treatments irrevocably denude the microbiome triggering chronic immune dysfunction and inflammation.(19-23,26)
IBS is a gut-brain interaction disorder(27,28) with 50% of sufferers experiencing gastrointestinal symptoms only.(29) Co-occurrence with anxiety / depression is 44 to 84%,(30) with somatic comorbidities including agoraphobia, and insomnia(11) associated with more severe symptoms, reduced QOL, and increased physical and mental distress.(17) Panic, neurasthenic and depressive disorders consistently result in poorer IBS outcomes,(31) and require psychotherapeutic treatment.(32) Serotonin (5-hydroxytryptamine), a major pathophysiogenic factor in IBS, has a prominent role in controlling gastrointestinal motility.(33)
Psychosocial IBS research, via the maternal separation animal model, has shown this early life stressor induces colonic hyper-contraction, gastric hypersensitivity, and delayed emptying.(16) The stress response restricts recovery(34) and increases harmful commensal intestinal bacteria(35) in IBS which is also classified as a functional somatic syndrome.(11,17)
Australian prevalence of IBS is 14% using Rome I, II, III;(36) 8.9% by Rome II;(37) and 3.5% via Rome IV – rates of Rome IV diagnosed IBS are much lower than in earlier incarnations of the Rome criteria.(2,38)
Current IBS treatments
Low quality pharmacologic and non-pharmacologic IBS studies make treatment guidelines challenging.(39) The American College of Gastroenterology recommends chloride channel activators and guanylate cyclase activators for global IBS-C, and rifaximin in global IBS-D(1) although it has lower efficacy than alosetron and eluxadoline.(7) Antispasmodics provide short term symptom relief comprising first-line treatment for pain-predominant IBS and IBS-D(7) but induce adverse, anticholinergic effects.(40) Linaclotide improves stool frequency, constipation severity, and abdominal pain and discomfort in IBS-C,(40) but tenapanor is expected to take its place.(7) Over the counter laxatives may relieve IBS-C constipation without treating abdominal pain and discomfort.(40)
Gut-brain neuromodulators are prescribed for moderate to severe IBS associated with pain or comorbid psychological disorders.(7) Tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors are known to induce global symptom relief and improve abdominal discomfort.(39,40) Addressing psychological wellbeing improves IBS outcomes(42) with psychological interventions improving overall symptoms and relieving abdominal pain.(39) Gut-directed psychotherapy and a low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet are routinely recommended for global IBS symptoms.(1) Evidence for the use of probiotics is mounting but specific strains and molecular targets remain to be determined.(27) Cognitive Behavioural Therapy interventions and gut-directed hypnotherapy have proven efficacious in long-term treatment,(42) with an Australian trial showing gut-directed hypnotherapy as effective as a low-FODMAP diet.(43)
Hausteiner-Wiehle and Henningsen(29) implored treatment structures abandon classification of purely organic or purely mental disorders by acknowledging the variability of IBS through awareness of extraintestinal and psychobehavioural symptoms, and the implementation of a collaborative care model as IBS is a multifactorial disease requiring clinical, psychological, and biochemical evaluation.(17)
Complementary Medicine may be beneficial for global IBS symptoms,(44) with mucoprotectants providing some protection against altered intestinal permeability, dysbiosis, and mucosal micro-inflammation in IBS-D.(45) Gut-brain axis interaction induced by Chinese medicines have been noted in several studies,(46) and acupuncture has shown IBS treatment effects lasting up to 12 weeks.(47) Systematic review showed a little overall IBS symptom improvement after homeopathic treatment but, as for all IBS treatment studies, certainty of evidence is low.(39,44)
Homeopathy
Gastroenterological complaints are commonly seen in professional homeopathic practice.(48) Homeopathy, a therapeutic medical system based on the theory of like cures like - that disease can be addressed via the use of the substance which produces similar symptoms to the disease,(49) is a hotly debated but often used medical intervention,(50) which can significantly improve QOL.(50-52) Utilizing substances sourced from nature i.e., minerals, and plants, homeopathic medicines have passed through a dilution process called potentization.(53) Public health regulation framing the practice and use of homeopathy in Australia is legally supported by the Therapeutic Goods Act of 1989.(54)
Until recently it was thought that homeopathic medicines were inactive dilutions beyond Avogadro's number (<10to23), but biological activity and proprieties of the initial source material are retained(55-57), hormetic activation has been observed,(57) and distinct promotion of B-cell activity has been shown,(58,59) in infection control(60) with Th1 promotion by homeopathic medicine enabling a more efficient inflammatory response, leading to resolution of disease.(61) In vitro anti-pathogenic effect of homeopathy in intestinal microbiome resistance against Escherichia coli has been observed.(62) Electron spin inversion is currently postulated as an effect measure of a homeopathic medicine within an organism.(63)
Homeopathy is used by 6.8% of Australian adults,(64) and gastrointestinal health related conditions comprise 9.3% of Australian professional homeopathic consultations, evincing alignment with health needs of the general Australian community, and highlighting IBS research as both valuable and within scope of practice.(65) Just 0.14% of the Australian research budget was spent on CM in 2012,(66) despite Australia having some of the highest rates of CM utilization in the developed world.(67) Australia's National Health & Medical Research Council 2015 homeopathy review concealed the existence of an earlier 2012 review, contained numerous instances of bias, procedural and scientific misconduct,(66) and excluded any homeopathy research experts,(68) concluding no reliable evidence for homeopathy.(69)
Homeopathy in the treatment of IBS
Two systematic reviews of homeopathy in the treatment of IBS were conducted in 2019 - Peckham et al., (70) found inconclusive evidence for efficacy or safety, and Pacheco et al., (71) noted very low certainty of evidence, but overall self-reported symptom improvement. A 2021 pilot study showed a significant decrease in severity of symptoms and pain after homeopathy treatment, highlighting the importance of individualized medicine regimens.(72) A Randomized pilot trial comparing non-individualized to individualized homeopathy (IH) was inconclusive.(73) A Randomized Controlled Trial showed clinically relevant changes in symptom severity scores in 62.5% of patients in the homeopathic treatment arm and 25% in the usual care arm.(48) Outpatient dysbiotic gut symptom improvement,(74) Australian retrospective case studies of resolved gut symptoms(75,76) and chronic candidiasis,(77) and altered dysbiotic gut microbiota,(78) achieved with homeopathy have been documented.
Homeopathy is frequently used by anxiety sufferers(79) and shows possibility of benefit in psychiatric complaints(80) such as depression and anxiety disorders.(81,82) Alleviation of stress response with homeopathy has been shown in pigs,(35) and meta-analysis identified greater efficacy for homeopathy over fluoxetine in major depressive disorder.(83)
A fibromyalgia and homeopathy RCT showed significant improvements in pain, QOL, global health and a trend toward less depression,(51) and small, but specific, treatment effects may be seen in twenty-four medical conditions for IH(84) which was found to be non-inferior to fluoxetine in the treatment of depression. An eight-year IH observational study recorded considerably increased physical and mental QOL sores, with female gender and more severe disease presentation at baseline factors predicting better therapeutic successes.(50) An Indian IH observational study associated significant benefits for patients suffering from depressive episodes,(86) and Prousky considers IH a psychotherapeutic technique.(87)
Individualized homeopathy
Individualized homeopathy (IH) is homeopathic medicine administered according to symptoms and Level of Health,(53) enabling insight into, and estimation of, pervasiveness of pathology,(88) and prognosis for both the reactions during the treatment process, and the likelihood of successful treatment.(89) Levels of Health evaluates reaction to a homeopathic medicine as improvement, moving in the right direction, or neither,(78,89) while accurately defining and classifying adverse reactions / aggravations.(90)
High faecal calprotectin is a very sensitive biomarker which can be used to differentiate Irritable Bowel Disease from Irritable Bowel Syndrome.(91)
Sarah Penrose BSc(hons)Hom. is an Australasian homeopath and can be contacted at goodhealthforgreatlife.com
References
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