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Re: MMR vaccine and autism - IBS

Posted by Alamo Joe on September 12, 2001 at 14:01:13:

In Reply to: Re: MMR vaccine and autism - IBS posted by Alamo Joe on September 12, 2001 at 13:59:38:

The relationship between inflammatory bowel disease and sleep related breathing disorders.

Correspondence [1] presents strong statistical evidence that obstructive sleep apnea, a sleep related breathing disorder, underlies irritable bowel syndrome, of which one of the symptoms is diarrhea. Another letter [2] assigns sleep related breathing disorder as the cause of nocturnal reflux. Instead of two different underlying disorders for reflux and irritable bowel syndrome, there is a single underlying factor which involves two different mechanisms associated with diaphragm motion. Diarrhea with esophageal involvement is one way to describe Crohn’s disease.

There is no reflux involvement in ulcerative colitis, but diarrhea is definitely a characteristic which caused by sleep related breathing disorders.

Additional evidence that sleep related breathing disorders underlie inflammatory bowel disease comes from a study of irritable bowel syndrome and inflammatory bowel disease. [3] In this study the researchers found that during premenstrual syndrome both sets of patients experienced increased diarrhea, implying the same underlying factor.

Smoking has unique opposite effects on Crohn’s disease and ulcerative colitis. Smoking seems to be protective against ulcerative colitis, while smoking increases the symptoms of Cohn’s disease patients.

Ulcerative colitis symptoms are decreased by smoking. [4,5] Smoking reduces total sleep time [6], percent of time in REM sleep stage [6], frequency of events [7] and duration of events [7]. Each of these reductions attenuates intestinal trauma thus lessening bowel disruption in ulcerative colitis patients.

Although reductions in intestinal trauma result from smoking, smoking reduces the strength of the lower esophageal sphincter. [8] Consequently the force needed to open the sphincter is reduced and more fluids from the stomach will enter the esophagus worsening the esophageal aspect of Crohn’s disease. (The same paper reported “…reflux events occurred predominately by stress induced mechanisms such as deep inspiration or coughing…”.) The gastric fluids contacting the airway will cause inflammation and reduction of airway size increasing risk for more apneas and/or worse apneas.

This communication has presented evidence that sleep related breathing disorders cause both ulcerative colitis and Crohn’s disease.
1) Herr, J. Irritable Bowel Syndrome and Sleep. Submission to Dig Dis Sci (#01-199)

2) Herr, J. A Possible Pathologic Link Between Chronic Cough and Sleep Apnea Syndrome Through Gastroesophageal Reflux Disease in Older People. Accepted by Chest

3) Kane SV, Sable K, Hanauer SB. in The Menstrual Cycle and Its Effect on Inflammatory Bowel Disease and Irritable Bowel Syndrome: a Prevalence Study. Am J Gastroenterol 1998;93:1867-1872

4) Green JT, Rhodes J, Ragunath K, et al. Clinical status of ulcerative colitis in patients who smoke.Am J Gastroenterol 1998 Sep;93(9):1463-7 (Abstract)

5) Thomas GA, Rhodes J, Green JT. Inflammatory bowel disease and smoking--a review. Am J Gastroenterol 1998 Feb;93(2):144-9

6) Davila DG, Hurt RD, Offord KP, et al. Acute effects of transdermal nicotine on sleep architecture, snoring, and sleep-disordered breathing in nonsmokers. Am J Respir Crit Care
Med 1994 Aug;150(2):469-74

7) Goethe B, Strohl KP, Levin SL, et al. Nicotine: a different approach to treatment of obstructive sleep apnea. Chest 1985; 87(1):11-17

8) Kahrilas PJ, Gupta RR. Mechanisms of acid reflux associated with cigarette smoking. Gut 1990;31:4-10

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