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Functional gastrointestinal disorders: advances in understanding and management, 2020, Black, Ford et al

Discussion in 'Health News and Research unrelated to ME/CFS' started by Andy, Oct 15, 2020.

  1. Andy

    Andy Committee Member & Outreach

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    Paywall, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32115-2/fulltext
    Sci hub, https://sci-hub.se/10.1016/S0140-6736(20)32115-2
     
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  2. duncan

    duncan Senior Member (Voting Rights)

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    Oh, FFS. What's next, functional death?
     
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  3. chrisb

    chrisb Senior Member (Voting Rights)

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    It's already known as CFS.

    Cessation of Function Syndrome.
     
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  4. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    This is all about the self serving business of keeping people sick, keeping other specialities that might be able to help away and themselves on the gravy train.

    The whole gastric ulcer/heliobacter business all over again. At least in those days they came from a starting point of ignorance where as this shower don't have that excuse.
     
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  5. rvallee

    rvallee Senior Member (Voting Rights)

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    It's really amazing that the TL;DR of all those "advances in" and systematic reviews boasting of unquantifiable benefits never actually have any substance and are limited entirely to "if we could figure this thing out we may help, eventually, maybe". It's fan fiction.

    It's basically click bait, "here is the answer to this question" where the answer is nowhere to be found and people just marvel at how wonderful it would be if the explanation they favor were true and how they're (still, a FULL CENTURY LATER) working towards that.

    And 100% that without Marshall's team taking away peptic ulcers from these fanatics, ulcers would absolutely be a quintessential functional GI syndrome. The only progress that happens with these people is when patients are taken out of their reach by actual scientists.

    I mean seriously it says it right here:
    In some undefined future people may somehow formulate treatments that could be useful. That's not "advances", it's just imagining how things would work if this stuff were real. What are the advances here? Still not a hint of understanding, let alone management. And anyway most of their version of "management" is to have the patient self-manage without anyone knowing what's actually wrong, which is absurd.

    A full century of this and even in op-eds talking about imaginary "advances" they are still wishing and imagining how wonderful it will be if they actually came up with something but meanwhile people should continue to be "treated" despite there being no such thing. Zero respect for the human lives affected. Self-serving narcissists.
     
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  6. Kalliope

    Kalliope Senior Member (Voting Rights)

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    Lancet's full series on Functional Gastrointestinal Disorders is here:
    https://www.thelancet.com/series/functional-gastrointestinal-disorders

    In the first article of a Series of three papers in The Lancet, Christopher Black, Douglas Drossman, and colleagues elucidate advances in our understanding of the epidemiology, pathophysiology, investigation, and management of these conditions overall. The other two papers expand on the two most common of these conditions, as Alexander Ford, Ami Sperber, and colleagues discuss irritable bowel syndrome, and Ford, Sanjiv Mahadeva, and colleagues discuss functional dyspepsia.
     
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  7. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    This is absolutely absurd.

    One of the commonest effects of hypothyroidism is that sufferers develop severe indigestion and acid reflux. It is known amongst many patients on the thyroid forum I read that this is caused by reduced secretion of stomach acid. But before most of them find out the underlying cause of their gut problems they are told by GPs to take antacids, or they are prescribed PPIs (which switch off stomach acid secretion).

    Those who actually increase their stomach acid with vinegar or lemon juice in water, or betaine hydrochloride capsules, actually find out their indigestion and acid reflux actually go away.

    I once mentioned the low stomach acid problem to a GP and they denied it completely, and said indigestion and acid reflux was caused by excess stomach acid.

    One of the absurdities of PPIs is that they are more likely to be prescribed the older the patient is, despite the fact that the older someone is the less stomach acid they produce.

    Some people have found that improving the acidity of their stomach has had a beneficial effect on their IBS as well as their indigestion.

    I know that there are some circumstances where PPIs can't be avoided - for instance in the case of people being on NSAIDs. And some people with hiatus hernias have to stay on them too.

    In my own case, I had IBS for about 25 years. It was mostly cured by surgery that dealt with the adhesions I had that were sticking my bowel to the left side of my abdomen. I know that adhesions recur. But if the bowel is better positioned when it does get stuck down again it can reduce or eliminate IBS pain. So the surgery I had was worth it.

    None of the things I've described have any connection to psychology or depression or anxiety or "being all in your head" or "being functional" - and they can all be helped or even cured in many cases.
     
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  8. Hutan

    Hutan Moderator Staff Member

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    The clever/awful thing about this paper and the BPS approach in general is that it doesn't say that the biomedical issues don't contribute. So if a biomedical cause is identified in someone, the BPS clinician can never be wrong. It's just that they see the biomedical issue as such a small part of the problem - and the biomedical issue itself as probably the result of psychological/family issues.

    Screen Shot 2020-10-16 at 2.29.09 PM.png

    See there, top left, infection for example, it's there, in amongst everything else. And I'm sure that we all could agree that some behaviours, such as those around diet, can affect gastrointestinal function. It's hard to disagree with the literal idea of 'biopsychosocial'. It's the implementation of it, the automatic assumption that your medical condition is a product of your traumatic childhood and your moral weakness; the inability to believe the patient when they say that obvious things like a good diet, good sleep and exercise don't help the condition; the lazy lack of curiosity, where things go so dreadfully wrong.

    This paper allows for biomedical causes of 'functional gastrointestinal disorders' much more than most BPS papers. That should feel like a positive thing, a move in the right direction.


    Maybe I've read too many BPS papers, but to me the paper reads of a hedging of the bets.

    Well, yes.
    Hmm.

    So yeah, perhaps this paper is a sign of a welcome move to more caution before slapping a psychosomatic label on someone and offering them help to think about their symptoms differently. But I'm not getting too excited.
     
    Last edited: Oct 16, 2020
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  9. Mithriel

    Mithriel Senior Member (Voting Rights)

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    I would have more confidence in the concept of MUS or FNDs if I was sure they were actually looking at all possible biological causes before deciding there were none.

    Surely it needs more investigating before you can say there is nothing biological going on rather than doing less after a quick glance.
     
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