Talk:Irritable bowel syndrome/Archive 1

Preamble & Celiac discussion

Um, this page is a direct lift of the first paragraph of the first link provided. Koyaanis Qatsi 02:13, 15 Mar 2004 (UTC)

Well that sucks. I'll pop in a quick fix. Sorry if I screw it up. H2O 03:04, 15 Mar 2004 (UTC)

I am not a doctor - though I play one on TV. H2O 03:38, 15 Mar 2004 (UTC)

The trash can comment was made by my own physician, who shall remain nameless. H2O 03:25, 16 Jun 2004 (UTC)

Yes, but do you want to qoute every board-certified gastroenterologist on this whole planet?

Yes, but do you want to qoute every board-certified gastroenterologist on this whole planet? --Dbach 09:39, 16 Jun 2004 (UTC)

• No, just this one for now, H2O 11:58, 16 Jun 2004 (UTC)

Sorry H2O I had to rmv your celiac disease remark but it is not true that "many" patients with ibs suffer from celiac disease. Even from the patients having both malabsorption conditions, only a very small proportion actually has celiac disease. Dbach 09:13, 3 Jul 2004 (UTC)

• According to the NIH, one in 133 Americans (about 3,000,000) may suffer from celiac disease. It is much more common than was originally thought, and many sufferers do not display all the classic symptoms. [1] An NIH panel has recommended that the NIH undertake a massive education campaign to educate doctors about new blood tests that are available. There are people who are misdiagnosed with IBS who do not have IBS, but instead who have celiac disease. The statement in the article did NOT say people with IBS had celiac, but that many people with IBS "symptoms" had celiac instead. I will rewrite the statement, but people need to know about the possibility. H2O 20:00, 3 Jul 2004 (UTC)

• I am sure you know a lot about medicine. But I have to state that: people with "IBS symptoms" can suffer of anything because IBS symptoms can be similar to symptoms of colon cancer, exocrine pancreas insufficiency, and many other diseases. That is why you have to exclude them all, and not only celiac disease. (see paragraph rome ii criteria). Yes, there is a discussion about the prevalence of celiac disease but I would rather mention that on the celiac disease page. The only diseases really common among patients with IBS symptoms is lactose and fructose malabsorption. Among us: The main symptom of IBS is that patients are always worried they have a malign disease and the majority has not. I will put this into the rome II and differential diagnosis paragraph. Dbach 09:47, 4 Jul 2004 (UTC)

• By the way: if you read the articel carefully you will notice that the expert panel does not propose that patients with IBS symptoms are underdiagnosed but that the ones with unspecific general symptoms should be tested more carefully - and especially relatives of patients with autoimmune or probably autoimmune (DM I) diseases. IMO that has nothing to do with IBS. It should be incorporated into celiac disease. Dbach 09:57, 4 Jul 2004 (UTC)

• I don't claim to know as much as you doctors. I don't have the training or the experience. I guess I am fine with the way you have reworded this. The possibility of celiac disease does need to be mentioned in the article. It is a travesty that it takes on average 11 YEARS for a celiac patient to be diagnosed. I am personally very frustrated with physicians right now as I have been suffering continuously with abdominal pain for over a year and a half and no one knows why. If you were in continual pain you'd wonder too if you had some awful disease. My approach to these articles is to try to provide as much information as possible that might help someone from needlessly suffering. You physicians can really help by making sure that the information is accurate, but let's not take a gatekeeper approach. H2O 19:15, 4 Jul 2004 (UTC)

• It would be a good idea to mention Celiac's Disease in this article. I can tell you I have a friend who was diagnosed with IBS and suffered with it for 10 years until I finally convinced him to get a test for Celiac's disease and he came out positive. Any patient who is experencing IBS should have a colonoscopy (to rule out anything serious) and be tested for Celiac's Disease, especially if they are of Italian or Irish Heritage. I too was mis-diagnosed with IBS, when my problem turned out to be multiple food allergies (although mine are so rare, they are not worth mentioning). To add a blurb about Celiac's Disease is worth it if it saves just one person from suffering and dealing with a mis-diagnosis. Also, the study that was mentioned in the CNN article above stated that people without symptoms had a 1 in 133 chance, this is incorrect. According the the study, 1 in 133 people without any IBS like symptoms had Celiac's Disease. Of the 3236 patients studied that had IBS like symptoms 1 in 56 had Celiac's Disease. Here is the actual pub-med link [2]

22:07, 4 Jan 2005 140.251.31.53

(signature reconsctructed by Dbach 19:59, 7 Jan 2005 (UTC))

Celiac disease needs to be considered witrh every IBS patient. One in 20 IBS patient is really a celiac. Many centers will screen everyone. I tend to just check in those patients who do not respond to simple therapy for IBS. S Holland, MD Kd4ttc 18:10, 11 January 2006 (UTC)

Bias and vandals associated with this article

Just wanted to post this so everyone can see what is happening. I added some info on probiotics, without seeing 4 words mentioned in another sentence about the subject. Instead of simply relocating my contribution, IBSGroup deleted it entirely w/o specific reason. I then relocated the data, which provided some helpful (and non-repeating) background on the suspected mechanisms through which probiotic help. There was a specific reference to a bonafide and well-known Medical Doctor and an article to a website review of probiotics giving some brands, strains, and other data. IBS Group deleted this data again, I added it back. Now all of a sudden someone under only an IP address has deleted the data with no reasoning.

My problems 1) The comments left on these edits left as simply "revert.." is not helpful. It is obvious there was a revert, but a valid reason should be given FOR the revert. This behavior is not consistent with good documentation habits. 2) Wikipedia is open and built on the contributions from people with a broad array of backgrounds and viewpoints. If one is to completely remove a contribution rather than alter as appropriate, then there should be a damn good reason given. This has not happened. 3) It appears that some people have taken it upon themselves to make this article exactly in their own vision. This is not in keeping with the idea of an open and collective process.

I am giving up, as this has become a waste of my time. I think it is unfortunate because I can see from here that others have had similar experiences with biased link editing and other scenarios. This is an outrageous abuse of other people's intellectual/free time that are legitimately adding useful information on here only to have it removed based on some kind of bias/ego problem.

Dropping an edit that referred to one physician's approach didn't fit into the tone of this article. The comment on why probiotics are beneficial was also not well supported by literature. Where the entry not written as a promotional piece but as a comment on emerging use of probiotics and discussion of possible relationship to inflammatory state in IBS it probably would have been better received. Kd4ttc 17:47, 12 February 2006 (UTC)

The definition of ANY hypothesis (YES that word was used) is that it is in the initial stages of the scientific process. Saying the view is not well-supported by "literature" is redundant and not a valid basis for censorship when the motive is a comprehensive array of information. I don't see how sharing potential specific information with sufferers constitutes a "promotional piece." I am not being paid anything by anyone and I resent the implication of bias. While we are on the subject, I see that IBSGroup's own "nonprofit" website is chalk full of advertising, mostly for pharmaceutical products. He also says he has testified in front of the FDA for these pharmaceuticals. If there is any question of nepotism or bias, I think it is clear on whom it would fall.

Futhermore, I would like to share this excerpt from official Wikipedia policy. If this continues, I will take it to the next level:

"This means primarily: Do not simply revert changes in a dispute. When someone makes an edit you consider biased or inaccurate, improve the edit, rather than reverting it"

The comments on probiotics in IBS did not represent that it was still investigational or early in gaining clinical experience. As a hypothesis it needs to be described in fuller terms. Why don't you go and add something in that regard? The comment on taking something to the next level sounds like a threat. I do not think that is constructive. Jumping to a conclusion of vandalism also was not constructive, but why quibble. Perhaps a discussion on the talk page regarding probiotics would be appropriate. Steve Kd4ttc 03:12, 13 February 2006 (UTC)

I think there is now a happy compromise. From what I can see, the Doctors on this page are unhappy with additions to the IBS article that do not meet the criteria for validity used in their particular discipline. This has led to reverting additions along these lines without comment. I have added a section for "Alternative Treatment." The section is prefaced with an introduction explaining that Alternative Treatments do not come from the same thoughtframe as someone like a Medical Doctor might have, and thus the empirical data is often personal AND anecdotal. I think this should allow the censors out there to still feel the article meets their own criteria for validity while allowing others of different approaches to share other ideas within the context of a properly defined section. 64.186.246.122 18:46, 14 February 2006 (UTC)

Just because it is anotehr discipline doesn't change the requirement for verifiability. It still reads like an ad. You need a reference. I plan on adding some additional information on the problems with the alternative medicine apporach as well. I would also drop the attribuition to the researcher and leave a reference instead. Lastly, please set up an account. Editing as an anon is a red flag people who monitor the pages. Glad to see you posting on the talk page here. Kd4ttc 21:33, 14 February 2006 (UTC)

The point is that it is not necessarily 'verified' in academic journals, which are not the only valid source of information as has been indicated. For instance CTM is verified by more than 2000 years of experience from practitioners and patients. Generally this is not suited to Western-style testing because practitioners start with a common base and tailor treatment to individual needs. This does not lend itself to reproduceability in the strict clinical trial setting. However, if someone were to argue that because of this nothing from CTM is valid, they would be incorrect. I am sorry people 'red flag' anon, but the system is setup to work like this for a reason. Unless Wikipedia changes their system, I will not register. To me it is something of a matter of ego to go around flaunting one thing or another under one's name. Also, it is still unclear to me what "still reads like an ad." Perhaps you can point out what exactly is commercial or offer an alternative non-commercial rewrite of the offending sentence? I am sure criticisms to alternative approaches would add welcome perspective. 64.186.246.122 21:46, 14 February 2006 (UTC)

I didn't say an academic reference. Verified means you can look it up somewhere. Just any reference to start with. We can work on improving that over time. I reads like an ad cause it says ...recognized authority... . there is actually academic literature on this, so resorting to an unreferenced source is not needed. It is humous to see statements that an authority says so. In western medicine you look up the study. The authority may know where the studies are, but opinion is just that. Leaches were used a long time too, so durability of a practice does not meet verifiability as in it working. However, it is fun to see what people have been doing. Why won't you register? Pick a pseudonym, say something brief about yourself (like Country you live in, Nearest big city or time zone, and favorite color) and you get a user page and a talk page. With time people see you do good edits and your work is more durable.Kd4ttc 23:00, 14 February 2006 (UTC)

Verifiable insertions add to the credibility of this article. Insertions are reverted generally when they have no peer reviewed studies to support them and when they read like an advertisement. It's unfortunate that individuals take this personally and then violate Wiki etiquette. In terms of Alternative strategies a recent conclusion was:

Doctors caring for irritable bowel syndrome patients need to recognize the near ubiquity of complementary and alternative medical use among this population and the basis for its use. All complementary and alternative medicine is not the same and some, such as hypnotherapy, forms of herbal therapy, specific diets and probiotics, may well have efficacy in irritable bowel syndrome. Above all, we need more science and more controlled studies; the absence of truly randomized placebo-controlled trials for many of these therapies has limited meaningful progress in this area (Feb. 2006). PMID 16441466

Chinese medicine has not fared much better:

Although some traditional Chinese herbal medicines may help patients with irritable bowel syndrome, the evidence of efficacy is woefully inadequate, according to a systematic review by the Cochrane Collaboration (2006) [3]

In light of these two studies should the recent insertions remain in this article? Ibsgroup 01:51, 15 February 2006 (UTC)

I think now we are delving into the technicalities of scientific nomenclature. Edvidence of efficacy being inadequate is not the same as having contrary evidence. Even then, something might not necessarily be "disproven." Also as detailed above, clinical trial type evidence may likely never exist in large quantity because Chinese medicine does not lend itself to reproduceability, which is essential element of the Western scientific process. As it also says.. this sort of thing is ubiquitous. I think removing the entries would be ignoring a huge aspect of the IBS phenomena (if we can call it that). If various types of alternative medicine are 'disproven', then we should say so with evidence, or if there are not clinical studies, then we should say so.... but I think it would be an ignorant approach to not address this type of thing in any matter and play ostrich with head in sand so-to-speak. Again, as is standard if an insertion seems to be say "uncomprehensive" or "uninclusive" or all perspectives, then we alter insertion accordingly, but not deleting it. The entire fiber of Wikipedia is based around non-destructive alteration. Read the language on vandals, deleting something entirely is ALWAYS last resort. 64.186.246.122 19:12, 15 February 2006 (UTC)

>Verifiable insertions add to the credibility of this article. Insertions are reverted >generally when they have no peer reviewed studies to support them

Just wanted to followup that perhaps we are off somewhat on the mission of an "encyclopedia." These type of things no matter how well written will never be a valid academic source. I don't know of any Professor/University in this country or even High School of any reputation that would allow someone to use a commercial Encyclopedia, much less Wikipedia as a source. The reason for this is #1, the articles are usually not written by experts (at least not preeminent) in the particular field. #2 the articles are "encyclopedic" and contain a huge variety of information. Just because an article addresses various approaches does not in anyway cheapen the article beyond it status already as an encyclopedia entry. I might point out many of the pop culture/historical articles which address conspiracy theories. The mere presence of the conspiracy theory itself does not debunk the entire article. The important thing is how the theory is addressed. IMHO not addressing some of these theories actually leaves a huge credibility gap and questions in the mind of the reader.64.186.246.122 19:26, 15 February 2006 (UTC)

That is not acceptable. Wikipedia is not the place to write about things not yet proven. It is for statements that are verifiable. Chinese medicine does claim reproducibility. The accupuncture points are supposed to be something that is learned and applied. What has not been done are trials that confirm the utility. As the anon is not interested in providing references the section is now going to be edited with verifiability as the goal. The above comment with the referenced articles about the status of alternative medicine approaches is a better edit. I'll add it later. S Holland, Kd4ttc 23:06, 15 February 2006 (UTC)

I don't know how else I can put this, I apologize if perhaps I am not clear. You are using the word "proven." Your idea of proven is by using Western Scientific Trials. Wikipedia requires that material be "verifiable." The threshold of this word is significantly broader than what you are comprehending. Part of the problem here is that some of the people attacking this section are obviously not well-versed in science (perhaps one small branch of application, but NOT science in general). "Clinical trials" deal with the empirical, which is measured through repeated clinical tests which are reproduceable. Acupuncture does not meet this threshold, therefore "clinical trials" are not well adapted to judging anything about it. I think obviously you are speaking out of your area of expertiese when you say that Acupuncture is as such. I am not going to take the time to explain it to you, because it is clearly covered in an article of its own (ON ACUPUNCTURE... maybe soem of us should read it?). What you just stated you are going to do is take your narrow definition of "proven", using a system of testing which does not possess the tools to test the veracity of the subject matter in question and delete said subject matter according to this criteria. I will quote from the "About Wikipedia" page...

"Editors are encouraged to uphold a policy of "neutral point of view" under which notable perspectives are summarized without an attempt to determine an objective truth."

I suggest that your threatened censorship is exactly this; a forced imposition of your own objective truth. Without trying to be personal, I really cannot believe how petty and closeminded the people that have written/monopolized this article are. We have Doctors, vying only for clinical trials -- precisely and only the one form of data they are trained to understand in Medical School. The statements about Acupuncture state what Acupuncture believes the cause of IBS is. How are you going to fight this as not verifiable? Clearly Acupuncture (out of your area of knowledge) DOES believe this is the cause. I could see if the claim was made "This is the cause of IBS, period." ... but in fact we are just stating another discipline's viewpoint. Can we just try to be a little open-minded? Like I said, this is under request for mediation. If you are anti "alternative" as clearly it appears, and you edit this article.. then that is not neutral-point of view, that is bias. You can keep changing criteria and using circular logic with me, but it is not going to change the fact that the Doctors here want only their clinical studies, and that is neither comprehensive, inclusive, nor acceptable.

above added 04:20, 16 February 2006 by anon User:70.95.199.228

please follow guideline of Wikipedia:Sign your posts on talk pages. David Ruben ^Talk 03:32, 16 February 2006 (UTC)

I quite agree, this is unaceptable on so many levels. We have not changed the goal posts, we do not have ties to pharmaceuticals with a hidden agenda, we simply want an article that is accurate. It would be so helpful if you included evidence based material and not commercially based anecdotal information that perpetuates lukewarm information. Ibsgroup 03:37, 16 February 2006 (UTC)

Anon, youhave now gone on for a long time without any sort of reference at all. Not a web page, not a book, not a magizine, nothing at all. I said before it didn't have to be academic. Just something. Did you just make this up? What was your source? I think you need to reread my comments. I pointed out above that proven was not the issue, it was if it was verifiable. Kd4ttc 04:07, 16 February 2006 (UTC)

I have added two references, they're clearly visible on the history page. They've been there in synch with every contribution I have added. I can't even believe I am discussing this content with you, when you haven't even looked at it! I didn't address that aspect of your replies, because I couldn't believe you really had not figured this out already yourself (?) Now we're back to the references again. Let's continue discussing the Acupuncture, as you have made some good constructive criticism on the probiotic piece imho. So, at issue is what Acupuncture sees as the cause(s) for the condition diagnosed as IBS. There is a reference to a Licensed Acupuncturist (a well-known and well-trained one at that) giving extreme detail in this regard. What is the problem here? If you disagree that the posted edit does not accurately convey what Acupuncture sees as the cause of IBS, why don't you post an appropriate edit with references? Again, at issue is what ACUPUNCTURE sees as the cause of IBS, not your personal viewpoint or evidence from other trials/journals. 70.95.199.228 04:35, 16 February 2006 (UTC)

• I note, User:70.95.199.228, the points you raise with interest (thanks for now signing your talk-page edits), of course the issues are somewhat applicable to more than just this article, but to all topics where there is a non-conventional approach. I also note your correct use of a talk page to have a WP:Civil discussion. I would comment to both sides:
• You are correct that well-established alternative approaches, as acupuncture surely is, (irrespective of whether one thinks they truly work or not) are clearly at least a valid significant minority opinion for which you correctly cite the WP policy as requiring appropriate mentioning.
• I think it is perfectly possible for those personally holding a particular POV to contribute in a NPOV manner, e.g. would anyone dispute the neutralness of a phrase such as "Acupuncture has long been used in Chinese medicine for the treatment of this condition", despite myself personally being a sceptic ? Contributions by editors holding opposing POVs is probably helpful in ensuring a complex article has both accurate breadth & depth to its coverage.
• The difficulty is in making comments on the effectiveness of any particular approach. I hope everyone can agree with a statement such as "all treatment modalities, whether conventional or alternative, are anecdotally reported by many patients to be helpful" - for patients do so "report", which makes this notable and thus NPOV. Such a statement of course is making no attempt to assign or diminish claimed effectiveness and so any editor (whatever their own POV) should be able to submit or agree to such an edit in wikipedia.
• However it would be nice to be able to state how many find effective and indeed how effective placebo effects are (both for conventional and alternative methods). I know conventional medicine has tended to dismiss placebo effect, but it does exist (even with conventional therapies) and we should be grateful for any benefit to patients (of course it would be nice if a treatment modality confers additional benefits than just placebo). To provide some numerical description of effectiveness, one ends up having to do some form of study, rather than just resorting to a bland phrase such as "anecdotal reports by some patients".
• I disagree with you though that alternative (e.g. acupuncture) medicine can not undergo similar double-blind controlled trials. One can test against non-treatment groups, sham-treatment groups and indeed conventional medicine groups. Recently very good TV series in UK about Alternative Medicine, narrated by a clear sceptic who is rightly impressed by some very creative and useful studies - elevating ones appreciation for placebo or therapist effects and that selectively some alternative practices in selected cases may have real effects.
• The real problem is the lack of finance to undertake well constructed studies and with large enough number of patients to be able to draw clear conclusions. In addition I suspect that some alternative practitioners have perhaps too firmly held onto their own belief that their modality could not be subjected to scientific studies. So I sort of accuse both Conventional Medicine for being unwilling to assist their Alternative counterparts in setting up suitable studies and of Alternative practice being unwilling to creatively accept that studies can be undertaken.
• Of course some alternative medicine's apparent non-scientific view points on their mechanism of action has not helped source suitable funding, but there again until recently the use of willow-bark as a pain killer was not understood (it essentially contains aspirin and we now have some understanding of the biochemistry of inflammation, pain-gate theories etc etc). However some good studies on acupuncture now seem to be starting up and the use of real-time MRI & EEG studies suggests some very real effects..
• Returning to how to edit this article. It is should be NPOV to state that acupuncture has or has not been used for any particular condition, likewise to report whether it is believed than at least some patients report benefits. It should be NPOV to point out whether good scientific studies have or have not be developed and run to look into a particular method and what the base-line conclusions were. The problem is of course that too often there is a lack of studies, which of course logically can not be used to infer whether a method does or does not work (just that there is a lack of evidence to substantiate a claim). It is this last aspect that needs great care if wikipedia policy is to be observed.
• I think all editors to this article/talk-page have shown ability to look deeply into the issues and hope you will continue discussion to reach the required consensus of how to develop this article further. I have no great expertise in this particular subject matter (I’m only a mere GP who has seen patients responding or not to a wide variety of treatments and only just reached 1000 wikipedia edits), and have no desire to see this debate deteriorate into an edit-war, which no one likes. So please let me know if there is any way I can help on NPOV additions to this article - or if to mind my own business :-) David Ruben ^Talk 04:50, 16 February 2006 (UTC)

Second that. Kd4ttc 15:51, 16 February 2006 (UTC)

I believe it is fair to say that we have are completely openminded to any type of therapy where evidence based studies support it. Providing references which are from a commercial source or from a personal page, in my mind, does not constitute a valid reference. There are numerous studies which indicate efficacy for Acupuncture where an individual has been diagnosed correctly as having IBS via the Rome II or even the Manning criteria. Reference one - anyone. Probiotics also have had some useful studies, namely Quigley (2005); however referencing Weil, who has no studies, comes across as quackery medicine. Simply stating that an alternative therapy has helped individuals does not provide any reference as to whether the individuals actually sufferered from IBS in the first place. I maintain that the Alternative therapy section continues to further perpetuate myths about this illness. Unless you state some valid references, I can't see why, at this time, it should be included in this article. Ibsgroup 14:31, 16 February 2006 (UTC)

"diagnosed CORRECTLY as having .." -- Bias. Correctly is when they use YOUR method. Nice.
"openminded...where EVIDENCE BASED STUDIES.." -- Bias. We've been over this.
Now Dr. Weil is a quack? Wow that's news to me. Do you have any idea how many books he has sold alone? No offense, but I'd like to see your qualifications in Integrative Medicine that make you a bigger authority than him, and support your basis for calling him a quack based on his recommendations under the guidelines of that field. As I stated in my comment, at this point in the discussion, the matter at hand is what Integrative Medicine views as the cause(s) of IBS. You did not address that point. If your disagreement is with the validity of Integrative Medicine, then that needs to be addressed in the Integrative Medicine article. Likewise with Acupuncture.

" Unless you state some valid references, I can't see why, at this time, it should be included in this article. " -- Now here's the beautiful part about a collective effort. It does not require you to see why. In fact it is quite likely that not everyone will follow the intricacies of every section. That is when we admit we don't understand and let others with more knowledge in the area handle the situation.

as quotes from another person on the discussion board:

• You are correct that well-established alternative approaches, as acupuncture surely is, (irrespective of whether one thinks they truly work or not) are clearly at least a valid significant minority opinion for which you correctly cite the WP policy as requiring appropriate mentioning.

Again as quotes from Wikipedia policy on the front page, about section:

From Wikipedia policy...

"Editors are encouraged to uphold a policy of "neutral point of view" under which notable perspectives are summarized without an attempt to determine an objective truth."

It's a "notable perspective" and that is why it must be included, whether or not you agree with it. Obviously you do not.

70.95.199.228 17:15, 16 February 2006 (UTC)

I was hoping that the reference would be put on the talk page here so there would be no confusion as to which reference one is discussing. I don't see anything in the history page. There are two external links I see, * Probiotics - A Mixed Bag for Sufferers of IBS, Irritable Bowel Syndrome - A Traditional Chinese Medicine Perspective are not really references. They are just web sites where a couple of people say they did something and feel good. Given that there is a 40% placebo response rate to treatments that doesn't mean much. Anon: Were those the two references? Never underestimate the ability of another editor to miss something written elsewhere in the article. Kd4ttc 15:37, 16 February 2006 (UTC)

--Article split here see next section--

My first visit to Wikipedia and am almost turned off by all the verbal garbage going on. This almost seems like a personal vendetta between two key people.

The big problem here seem to be that neither is prepared to accept anything from the other, picking on any small point available. The big factor here is that words only are relied on for the passage of information, pity that words alone make up no more than 7% of any communication.

The long drawn out, and generally fruitless discussions seems to be nothing more than a total waste of editing space.

Cheers

Acupuncture and IBS

I'm splitting this thread up. Too long. This section was split from the vandal section.

"Anon, youhave now gone on for a long time without any sort of reference at all. Not a web page.."

Websites are not intrinsically bad sources (as it appears you just stated above?), in fact they are allowed sources on Wikipedia. Now that you actually know there are two sources, I suppose we can discuss their validity at some point. However, let's stay on topic with the current thread of discussion on Acupuncture. Now your claim is that the source provided is comprised of "people say did something and feel good." If we in fact read the source, we see it is a published Master in Chinese Traditional Medicine discussing the discipline's viewpoint of the causes of IBS. Do you disagree that this is the viewpoint of Acupuncture, or even one viewpoint of a school of thought in Acupuncture? I think you are right, about the underestimating. I will assume in the future that you have not read what you are criticizing, as in the reference section of the article or in the case of the content of the references. I remind, the issue at hand is not the inclusion of Acupuncture itself as a notable perspective. This is clearly covered by policy (see above). Before we can discuss other aspects, we must agree that this is the/a viewpoint of the discipline. If you take this off-topic we will never finish this discussion. 70.95.199.228 17:15, 16 February 2006 (UTC)

Sorry not be be able to parse the article as well as you are. What is the ref from the master in Chinese medicine? Kd4ttc 17:40, 16 February 2006 (UTC)

First, and this it not a huge issue, but Acupuncture is spelled incorrectly as "Accupuncture" in the heading of this section.

Look, I am not going to waste my time playing games with you. There are two references, I have added. One is regarding Acupuncture and is attributed to Al Stone, L.Ac. Now, what site of the two do you think I might be referring to you? Use some of that MD intuition ;p Now you have not addressed the issue, which was made clear in my last edit. Should we assume the issue is now at rest? 70.95.199.228 18:36, 16 February 2006 (UTC)

We seem to differ with what constitutes an individual who may or may not have IBS and what approach to treatment may be suggested by their physician. I would be interested to understand your definition of the diagnostic criteria. I am not clear why we are still discussing Acupuncture or Probiotics. There are studies which show some efficacy for IBS. I believe we are asking for you to reference one for each that is not from a personal opinion and one which is evidence based. Quigley (2005) is already referenced for Probiotics. Are you aware of a study that Weil has on this subject? Quackwatch.org lists [4] for Dr. Weil. Wrt to Chinese Medicine approaches, I have not seen any literature which shows efficacy. I don't understand why we are continuing to carry on like this as we are going in circles for the sake of going in circles. Perhaps if you shared your credentials we would understand your perspective. Ibsgroup 22:33, 16 February 2006 (UTC)

The issue is not 'my' criteria, or 'my' credentials. We don't share original research on this website. In fact, I believe part of the problem here is that some of us might see this alternative as a threat to our own qualifications, personal reputation, or credentials. We are discussing what Acupuncture views as the causes of the condition diagnosed as Irritable Bowel Syndrome. I have stated what they see as several causes and provided a reference to an authoritative source. That's "verifiable" end of story. Beyond that, you really have no argument unless you have another verifiable source, showing what Acupuncture views as the causes of the condition. You guys keep bringing up trials, which are conducted by other disciplines and irrelevant to this particular statement. If you want Acupuncture itself to be proven, usign your clinical trials then again, that is something for the Acupuncture article. At this point we are merely establishing some very basic and general statements on how Acupuncture sees IBS. I don't understand why we are carrying on like this either. Acupuncture is a notable perspective, a statement has been made on how it views an illness, that statement is verifiable through an authoratative source on the matter. That should really be the end of the discussion, but you guys keep talking about censoring this or that because there is not a clinical trial. At issue is merely what Acupuncturists see as the cause for something, not whether it is right or wrong. That may very well be attacked, but we first have to agree on what they believe.70.95.199.228 02:53, 17 February 2006 (UTC)

I refer you to 2 recent studies about the lack of efficacy for acupuncture. If you can reference something different than please post it.

Despite occasional positive reports on the efficacy of acupuncture on functions of the gastrointestinal tract, there is no conclusive evidence that acupuncture (AC) is effective in the treatment of irritable bowel syndrome (IBS) (2005). PMID 16150852

Traditional Chinese acupuncture is relatively ineffective in IBS in the European hospital setting, and the magnitude of any effect appears insufficient to warrant investment in acupuncture services.(2005) PMID 15996029.

Ibsgroup 04:18, 17 February 2006 (UTC)

At issue is merely what Acupuncturists see as the cause for something, not whether it is right or wrong. That may very well be attacked, but we first have to agree on what they believe. 70.95.199.228 06:21, 17 February 2006 (UTC)

70.95.199.228 I agree this is the question, but specifically of importance is who believes, i.e. is it all, most, some or one prominent accupuncturist ? Could I suggest the issues are broken down (see my previous discussion). Some of these many already have been accepted by both sides, but it would be useful at this point to summarise and check-off each point:

• Do any accupuncturists claim to have an alternative understanding as to the cause (vs merely offering an alternative method of treatment for a condition which they accept the conventional pathophysiological explanation) ?
  • If so, then is this all accupuncturists, some, or a minority with perhaps the rest accepting conventional explanation but feeling they have an alternative treatment modality ?
  • If virtually all accupuncturists DO hold similar belief on a causation, then:
    • I accept it might be difficult to find a reference (e.g. I might struggle to find a reference to support the fact that all (vs. just some) Family Doctors (GPs) see cases of sore throat or the common cold - yet we all know that every GP will probably see a case on most days)
    • It might be better to cite a more neutral source (eg a standard manual on accupuncture) for this factoid rather than one (controversial) author's book. 70.95.199.228 please understand that this would get the point about alternative causation and who holds this belief into wikipedia without arguments over whether a book vs. refereed journal, or one author etc counts as acceptable source in wikipedia. Remember the aim of an encyclopaedia is to have articles with content and less about worrying about which of (hopefully) many sources one might reference. 70.95.199.228 you may have to be flexible on which source is cited as a reference, but see my thoughts on us "conventionalists" needing to be flexible about having the alternative understanding mentioned at all in the following point.
  • ) If amongst accupuncturists there is just a single proponent for a different claim of a condition's causation then this, numerically, is an insignificant minority view point amongst accupuncturists. However if the claimant is in their own right prominent (or indeed notably controversial) in themselves, then I think there is a case, in wikipedia, for their opinion to be mentioned, BUT with the caveat that wikipedia must indicate the opinion is not accepted by conventional medical opinion nor held by most other accupuncturists. As a silly example that I hope we all would agree upon: if the US President (or UK Prime Minister) were to start insisting that IBS is caused by wearing glasses and that all opticians are to be closed as a result, then wikipedia should having updated the article on his mental illness/removal from office etc, also make a note within the IBS article on the world-wide news scandal that followed.
• Do more than an insignificant minority of accupuncturists try to use this treatment method on IBS (vs. say back pain, anti-smoking etc), if so then this is notable ...
  • I'm just not familiar enough myself with accupuncture to know what conditions accupuncture is routinely used on. A single proponent (even if prominent or having high book sales) for accupuncture used in this condition is insufficient (one person is an insignificant minority), however if many or most accupuncturists would apply the technique to IBS then this, of course, is acceptable/notable/for inclusion in wikipedia.
  • Can we confirm that 'many accupuncturists would use the technique for IBS'.
  • If both parties accept that many/most accupuncturists would apply the technique for this condition, then there is no need to cite the obvious (but you will be educating me on the claimed routine indications of accupuncture)
• Finally does accupuncture work (note this is quite separate from the notability issues of claimed cause, or usage) ?
  • Repeated large double-blind random control studies (the controls being sham treatment and untreated groups) would be preferable.
  • Large observational studies are less authoritative (but do highlight possible/probably likelihood of an effect worthy of confirming by better studies).
  • If there is an absence of research-based studies on effectiveness, then the 'absence' should be commented upon (if both parties accept that accupuncture is used in IBS, then to state 'it does not work' or 'research fails to prove it works' would be POV, instead one should use a NPOV phrase more along the lines of 'to date there is an absence of research studies looking into its claimed effectiveness'). David Ruben ^Talk 14:01, 17 February 2006 (UTC)

I agree with David Ruben and I would like to see a note in the article which cites the findings from the studies noted above which report that there is a lack of efficacy for acupuncture based on repeated double-blinded studies. Ibsgroup 15:05, 17 February 2006 (UTC)

IBSGroup - You may find this helpful, since nobody here arguing the point has bothered to read the Acupuncture article. In the criticism section...

One of the major criticisms of studies which purport to find acupuncture is anything more than a placebo is that most such studies are not properly conducted. They are not double blinded and are not randomised. However, since acupuncture is a procedure and not a pill, it is difficult if not impossible to design studies in which the person providing treatment is blinded as to the treatment being given. The same problem arises in double-blinding prodedures used in biomedicine, including virtually all surgical procedures, dentistry, physical therapy, etc.

The Cochrane Collaboration reports [7] "(t)here is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral elbow pain." Oxford University reported [8] "There were no high quality trials of acupuncture for stroke that showed that it was beneficial." Using stricter criteria (e.g., double-blinding) than those used in formulating the NIH consensus statement, the Cochrane Collaboration evaluated studies on acupuncture's efficacy in treating a number of conditions, usually but not always finding evidence to be lacking or inconclusive [9].

Also, the ruling from the mediator has come down. I share it below and will be adding it into a comment in my edit.

Being involved in Science I rule in favour of you, after weighing up all of the evidence. You can re-edit the page to include your own ammendments. Please state in the Edit Summary that you have my support. If there are any problems do not hesitate to contact me. Best of luck. Cameronian 15:00, 17 February 2006 (UTC)

70.95.199.228 17:10, 17 February 2006 (UTC)

The above quotation from User Cameronian is complicated by issues discussed below in #Mediator called in without protocol. Kd4ttc 15:42, 23 February 2006 (UTC)

• User:70.95.199.228, I was trying to seek clarification on the issue of who/how many hold a different understanding of the cause of IBS. As to the points you raise (re studies and effectiveness).
  • Firstly I have just read the Accupuncture article (thank you for the sensible suggestion :-) ) but no specific mention is made of IBS in the section Accupuncture#Indications and Research just the example of "gastric acidity and some other gastrointestinal disorders", but it does not specify IBS - so could you educate me as to what other conditions accupuncture is typically used for ?
  • Secondly is it really difficult (vs the effort for any good study) to compare against controls ? I quite accept the issue of proceedure vs pills - indeed in the past people have undertaken fake coronary artery bypass surgery (just opened & closed the patients chest without any intervention to the coronary arteries) which showed (a) most of benefit for minimal coronary artery disease was via placebo effect (obviously not for severe disease) (b) huge placebo effect for what was previously thought cut-and-dry effective conventional approach, (c) I'm not sure how much one could ethically repeat such studies in the current medico-ethics climate.
    • Re accupuncture, surely one could have internal controls (eg effectiveness of 6, 9, 20 etc sessions), variations in therapy (accupuncturist or trained actor, applies needles in either ineffective locations or inserts needles at correct locations but to varying depths of penetration). The current UK TV series 'Alternative medicine' had a trained accupuncturist inserting needles at the correct location, but to varying depths, and they showed that 'blind' monitorers could measure differences in responses on real-time MRI scanning. I think the real problem is not that such research can't be done, but that is is very difficult to carry out (MRIs of recent invention and who has ready access to them ?) and the costs involved of setting up large studies over long periods of time - its difficult but not impossible, and yes very hard to see how the situation can be currently improved. David Ruben ^Talk 18:29, 17 February 2006 (UTC)

Dear David -- Thank you as always for your questions and interest in the topic. In terms of common belief as to the causes of Irritable Bowel Syndrome -- there is a bit of a culture gap. "Irritable Bowel Syndrome" is a Western Diagnosis, so most "IBS" patients that Acupuncturists see in the United States (or other Western countries) are prediagnosed by MD's like Gastrointerologists. Chinese Medicine sees the condition called IBS as varying sets of symptoms. These symptoms then have remedies applied to them. So what a Gastrointerologist sees as Irritable Bowel Syndrome, a Acupuncturist might diagnose the symptom "Diarrhea strong odor with burning anus" which has a discrete cause, and treat the cause. The other symptoms would be addressed accordingly -- but one would not diagnose "IBS" and then set about doing one treatment that is used for "IBS." I plan to clarify this a bit in the current edit, now that there is some independent confirmation that my effort in that regard will not be completely deleted.

I think the best way to address this, and what I have tried to do.. is take the most common symptoms of IBS, give Acupuncture's diagnosis and view as to the cause. As you said, this is a common enough thing so as to make it somewhat difficult to reference completely -- though I think showing written sources from authoritative Acupuncturists certainly satisfies the "verifiable." requirement. The best way might be to poll Acupuncturists, but that would be a huge project requiring lots of funding.

Interestingly enough, in my opinion this explains Western Medicine's inability to provide a test for IBS. The Rome Criteria et al just basically confirm IBS after the presence of a number of symptoms. It's like one having a headache for a couple months, and then a Doctor telling you that you have "Chronic Headache Disease." With most other conditions in Western Medicine one can be tested for the presence of a pathogen, a damaged organ, or something along those lines -- not IBS. It's just a matter of having a "Professional" confirm a set of symptoms. I am sure more will be known as time progresses. This is now the username associated with User: 70.95.199.228. Sarastro777 19:24, 17 February 2006 (UTC)

Thank you - you've just preempted the post I was struggling to put in as a clarrification on my above question (wikipedia servers & my internet connextion conspired against me). I think you have answered the question (ie are we addressing TCM's general beliefs or one particular authors different interpretation). I'll post what I was about to add anyway:

• Sorry User:70.95.199.228, I think I too am getting confused over what is being argued over - just before you consider your reply to points above (but please do answer the points on range conditions treated, difficulties arranging & funding suitable studies), can I just return to ask for some clarrification over the main point (of this thread) re models of causation:
  • TCM has a very well established belief that, in general (vs just IBS specifically), accupuncture works via addressing lines of energy/force through a person's body. The fact of this claim is well established, and should not be questioned by anyone. History of accupuncture & its belief system is described in relevant article as you pointed out - accepting the fact that such a widespread belief is held is separate from whether one personally subscribes to it or evidence proves it work (eg blood-letting in UK medical practice some centuaries ago)
  • However I thought the issue we are debating over is one particular author's belief and appropriateness of reference to their book (i.e. Dr. Weil). If I have completely lost the "plot" and the only thing he was stating in his book was a reinteration of TCM's traditional belief, then lets end arguing with some NPOV phrase such as "TCM has an different understanding of the causation of diseases, which it believes are better approached through herbal medicine or accupuncture modalites" and then one can note the difficulties or absence of EBM-type research to confirm its long historical use. If however a single author is claiming a variation of or entirely different explanation, then the notability of this needs to be cited (but not the issue of TCM belief in general, which is well covered in its own articles). David Ruben ^Talk 20:03, 17 February 2006 (UTC)

Ahhh, now I think I understand the viewpoint. This may make it difficult to add much to the article if TCM rejects the diagnosis of IBS being a real single condition. So this single article on IBS wont be the place to discuss all the different diagnoses that TCM thinks this relates to individualy in depth, but I welcome you explanation and I think it makes a good start to a NPOV section discussing TCM's belief. PS Welcome new user :-) David Ruben ^Talk 20:03, 17 February 2006 (UTC)

AH glad, I was able to explain that okay, then. Yeah I think Acupuncture doesn't reject IBS--clearly it is a set of symptoms that are real, I just would say it is accepted but addressed and recognized in that system through the constituent symptoms without being specifically named (there really isn't a need to name it separate if you treat the separate symptoms). Definitely we prob. don't want to go into extensive detail on every possible symptom of IBS and the corresponding TCM take on it. A general overview should be good though imho :-) Sarastro777 21:58, 17 February 2006 (UTC)

Thanks to the anon for clearly stating that one of the references was "http://beyondwellbeing.com/ibs/". I still do not see another reference. Until you explicitly stated that was the one I didn't want to infer it. That is a poor reference. One person says what he does. No context of history of accupuncture and IBS. No comments on what others are doing. There must be something better than that. It really is just a commercial link to my mind. It may constitute an external link, but certainly not a reference. The probiotic section is very weak and again has a poor reference. There are much better references on probiotics in IBS. There is a whole lot of discussion here about what acupuncturists do, but no references of any sort to explain where they stick needles, how many treatments are used, or other details to know what is really being referred to in accupuncture treatment for IBS. I am going to try to edit some according to advice that David Ruben gave. Kd4ttc 23:13, 17 February 2006 (UTC)

I see the reference now. I thought you had two acupuncture refs. You had just one. The other was a page from an individual on a BBS system. I am dropping that reference entirely. A single person named Andy25 is not a valid source. Kd4ttc 23:42, 17 February 2006 (UTC)

In my opinion the Alternative section is very poorly written. It also ignores the peer-reviewed studies which I referenced. When you get right down to it, how many people are really seeking the aid of Chinese Medicine? Having an external link simply skews this. Must we go to arbitration for every edit? Lastly, can you provide some reference for this As recent, small studies have showh that there is some intestinal inflammation present in the small intestine of patients with IBS and bacteria have protein binding sites on their surfaces it is possible that there are interactions of some bacteria with the intestinal tissues on patients. I do not believe I have ever read it except perhaps by Pimentel(2005). Regardless it is extremely controversial. I believe we've been waiting days for valid references for this whole section. Ibsgroup 00:04, 18 February 2006 (UTC)

First time you're not more well read than me on IBS! Another reference to a study is Gastroenterology. 2002 Dec;123(6):1972-9, and evidence that this is considered mainstream is at http://www.emedicine.com/med/topic1190.htm. Kd4ttc 04:10, 20 February 2006 (UTC)

The last edit to this piece is abhorrent. Illness is not explained by the concept of "Qi" -- if we do not understand what we are talking about, we should not be editing this section. Please. Also, it is beyond the scope of the section to prove or give possible explanations of the mechanisms through which Qi plays a role in the human body. This would be providing an end to "objective truth" which is against Wikipedia policy. Further, the entire discipline of acupuncture need not be justified to mention it here. That is done in the Acupuncture article.

Finally, this edit was chalk full of spelling errors, an indication of hastily performed editing. Please take time, understand what you are talking about, and don't simply make changes to make this alternative approach sound ridiculous. This is not NPOV. We needn't use arbitration if we can respect each other and provide non-biased edits. I remind you that arbitration was not necessary because *I* was the one reverting additions and trying to suppress the addition of this section. 64.186.246.122 00:33, 18 February 2006 (UTC)

The fact that it sounds rediculous is probably due to a vaque notion of "Qi". There is no known physiologic correllate to Qi. As a theory it doesn't have physiologic basis. My edit that included the statement that it isn't clear what is being done in acupucture in IBS was not addressed to physiology. I really was hoping someone would say where the needles were being inserted. Kd4ttc 01:11, 20 February 2006 (UTC)

No it sounded ridiculous because you didn't know what you were talking about, and somehow felt a need to edit that article. You couldn't even spell acupuncture. Qi no more causes illness than blood causes illness. I think you just need to quit adding stuff for the sake of adding or changing unless you have something to say backed by some type of knowledge more than racist/bias notions of disinformation. Sarastro777 17:12, 20 February 2006 (UTC)

Well, since you are so knowledgeable about the spelling of acupuncture you would be good enough to correct the mistaken spelling of acupuncture you made in the article. I have seen references online that indicate that illness arises when the Qi is not in balance. I see that you didn't indicate where the needles are placed in IBS cases. (BTW blood can cause illness. See subdural hematoma, pericardial tamponade, hemothorax, polycythemia vera, anterior compartment syndrome, and other references to blood causing problems). Next, making comments that other editors are showing "racist/bias notions" is a direct violation of the wikipedia policy to assume good faith. You are to stop that behavior on Wikipedia. Lastly, if you don't like it then edit it and put a note somewhere on the rationale for the edit. Thank you for setting up an account. It will simplify communications. Welcome to the community. Kd4ttc 17:58, 20 February 2006 (UTC)

I fixed the spelling of this section already and will fix any other sections I see. It is somewhat difficult when I have to keep retyping the same thing over and over. The nuance of the metaphor was that blood does not cause a disease in and of itself by its presence, otherwise we would all be sick. Just like blood, Qi can aggravate things but Qi is not an "explanation of illness."

I was actually going to post some acupuncture points, but for some reason you decided to delete the acupuncture-view causes of several of the symptoms of IBS. Without this information, posting random points would not be meaningful as people would not know what symptoms were being addressed through those points. Perhaps, you can put them back and then I can post some of the points used to treat those problems? I have already typed it myself at least 3 times.

Finally, I just call things like I see them. you deleted specific information and replaced it with "qi is an explanation for illness", a bunch of typoes, and some thing about studies which made no sense at all and didn't fit with the article. This must be very embarassing for you, so I apologize if my comments pointing this out made you uncomfortable. 70.95.199.228 17:43, 21 February 2006 (UTC)

Don't get in a worry about embarrasing other editors. If you think like that you will have constant worry about what other think and it will inhibit your edits. Get used to the retyping. Now that you have a user account you will have access to your watch list and you can see what of interest has changed. You should put something in about what an accupuncturist would do. Verifiable info, of course. Once your entries start looking verifiable you will see more of your contributions stay. Your comment about being very embarrassed on edits and making an apology strikes me as disingenuous. I will not be reposting things I deleted. If you want to insert go ahead. Having something verifiable is required, though. Kd4ttc 18:15, 21 February 2006 (UTC)

IBS Community

• IBS Self Help and Support Group
• IBS Self Help and Support Group UK
• IBS personal stories
• Help for Irritable Bowel Syndrome

Death to the external links JFW | T@lk 00:19, 1 Apr 2005 (UTC)

Amen Ibsgroup 03:13, 10 January 2006 (UTC)

External Links

I see no value in including links for the sake of including links. This article cannot afford to foster anecdotal "feel good" information. It really doesn't help to validate the illness. Ibsgroup 19:45, 11 December 2005 (UTC)

I reassert this and suggest that only non-profit external links be included. Ibsgroup 20:30, 7 January 2006 (UTC)

Help for Irritable Bowel Syndrome - no clinical studies, commercial in nature, somebodies personal opinion, etc... etc.... This is not an unbiased site which is providing non-anecdotal information. Ibsgroup 03:07, 10 January 2006 (UTC)

No point in continuing this. Removing the External links Ibsgroup 14:59, 10 January 2006 (UTC)

• Help for Irritable Bowel Syndrome - IBS education, treatments and community
• Irritable Bowel Syndrome Association - A nonprofit organization dedicated to helping sufferers of IBS by providing support and accurate information and education
• International Foundation for Functional Gastrointestinal Disorders - Education and research organization for gastrointestinal disorders, including IBS
• UNC Center for Functional GI & Motility Disorders - IBS multidisciplinary patient care, research, training, and public education
• The IBS Network - UK Based Charity, helping those with IBS

This is not an edit being made for the good of Wikipedia. It's simply an edit that removes all external links EXCEPT the one to ibsgroup which is listed in the References. I would also like to note that the categorization of the Help for Irritable Bowel Syndome site is inaccurate. All of the information on that site references current research in the field wherever possible, it is not simply somebody's personal opinion, and it provides a wealth of non-anectodal information. At this point, it's clear that personal issues are driving the addition/removal of external links. It would seem to me the best course is to revert to the previous External Links, all of which are legitimate, helpful sites for patients struggling with IBS. Hvan 21:59, 10 January 2006 (UTC)

Professional associations and notable patient support organisations should remain, but they need to be reasonable authoratitive and not self-serving. Not many of the above links fit that pattern. And Heather, please note you can sign your posts with ~~~~. The wiki will insert your signature automatically, as well as the timestamp. JFW | T@lk 21:50, 10 January 2006 (UTC)

Thank you, JFW. I appreciate your presence here. Hvan 21:59, 10 January 2006 (UTC)

Heather, it would be better if your reference was in the correct APA format, ie: referencing a URL to the content that was referenced rather than your whole website. It became rather tiresome while unnamed individuals kept coming to the article and simply plopping in Help for Irritable Bowel Syndrome for what seemed without regard to the greater picture, ie: to have this article represent verifiable non-anecdotal information. That being said, it would be great if the study which you have ongoing is published in a peer-reviewed journal when it is completed so it also can be referenced. Ibsgroup 16:27, 11 January 2006 (UTC)

Since this section has been revisited and others see value in having external links again, would it be appropriate to add the organization that I am involved in? Irritable Bowel Syndrome Self Help and Support Group and/or Irritable Bowel Syndrome Association Ibsgroup 20:51, 8 October 2006 (UTC)

I do not see the value in adding these links, or continuing to list the current external links. Adding any new link leads rapidly to the addition of many others, and then we will once again find ourselves in a battle over which links to include/exclude. In the past, most of the reasons given for those decisions came down to simple personal preferences and/or self-interest, and it seems likely things are headed in that direction again. It's easy enough for someone to do a simple dmoz search and find a long list of valid IBS sites. In fact, perhaps limiting the Wiki external links to a single link directed to the dmoz IBS list (Wikipedia's entry for dmoz even notes that it lists a high proportion of informational and non-profit sites)would be a simple and graceful solution to this ongoing (and tiresome) issue. Hvan 17:28, 20 October 2006 (UTC)

Treatment Advice

Including more soluble fiber ("white carbs", such as potatoes, pasta, rice, and white bread) in the diet is a non-pharmacological approach that has been known to provide some relief for many suffering from diarrhea-predominant and abdominal pain-predominant IBS, and possibly the other forms as well.

NPOV ?

This article, as most of the medecine part, are highly technical and thus lack NPOV, to me. Let me explain what I mean: When I see "Of the persons who have symptoms of IBS, only a proportion seeks medical help. However, there is not yet a predictor known for who will seek medical help and who will not.", i'm inclined to believe this has been written by a western medecine doctor or an affiliate thereof, as western medecine is *not* an answer to each and every problem.

Another example is this one: " Psychotherapy is another treatment option, however many patients refuse to undertake this. Though not specifically indicated for IBS, the use of antidepressant drugs (e.g. amitriptyline in a low dosage or an SSRI) to treat the symptoms is common and has positive effects for some patients." Use of anti-depresant to treat what has not been proven to have psychological origin? And besides, psychotherapy might be an option to some, but this word has religious sounding to me, or at least western culture ideology of "everyone's well being through psychotherapy", which is more of a motto than a reality to me.

Well, I happen to be constipated right now, but does it prove a point? Apart from that, i'm fine really, no irritation of any kind. ;)

Listen now, some of the language is slightly biased but you can easily correct it yourself. Your rant about Western medicine is a bit odd. You'd expect this about a disease that is highly prevalent in Western countries. You may include alternative viewpoints in the appropriate sections.

Fact is that IBS is poorly understood, and that a neuropsychological mechanism may jolly well play a role. Many IBS patients do derive benefit from SSRIs and tricyclics, but then many neurotransmitters also interfere with bowel motility (especially serotonin!) As stress is simply more prevalent in IBS patients, psychotherapy sounds reasonable (and works in many). Just because it sounds implausible to you does not mean it has no veracity.

I will have a little stab at the biased language, but I am also removing the NPOV tag, because nobody is conciously being biased here. JFW | T@lk 15:20, 3 Jun 2005 (UTC)

Greetings, we should likely merge the diagnostic and differential diagnosis sections. The Diff dx section doesn't actually contain any diagnosis but rather diagnostic tests. If we were to keep the section, we should add some diagnosis, such as: Bacterial Overgrowth Syndrome, Biliary Colic, Celiac Sprue, Chronic Mesenteric Ischemia, Colon Cancer, Adenocarcinoma, Diverticulitis, Hypercalcemia, Hyperthyroidism, Hypothyroidism, Inflammatory Bowel Disease, Lactose Intolerance, Pancreatitis, Chronic Peptic Ulcer Disease, Acute Intermittent Porphyria etc..... There are more, check Harrisons Internal Medicine book... (I am not a doctor on TV, but I play one in real life....)

Is the phrase "we prefer the terms IBS with constipation and IBS" truly a NPOV? (In "The ROme PRocess" section --C Hawke 18:30, 31 July 2007 (UTC)

Van Vorous

Van Vorous et el has no clinical basis and is based on her opinion which it seems benefits her monetarily. There should be discussion and perhaps links to evidence based information about this illness, ie: Drossman et el, Talley etc.. who conduct evidence based research. The description about alosetron is not correct and should include information about its availability only in the US under a restricted access program. The whole of Medication likely needs a re-write. Ibsgroup (talk · contribs)

Your additions are welcome, especially since you're citing your sources. The Van Vorous book should only be cited if many IBS patients notice improvement in symptoms as a result of her advice, and this has been confirmed (e.g. in newspaper or support group publications).

I warmly approve of using evidence-based resources for this article, for example Cochrane reviews, for the medication section. JFW | T@lk 15:08, 5 December 2005 (UTC)

In my opinion, unless the individiuals who report anecdotal QOL or symptom improvement as a result of the advice from Van Vorus' diet have been involved in a clinical study whereby they have been truly identified using the Rome II criteria, as noted in the Diagnostic Criteria section, then their remarks are also just personal opinions. I believe we should really enforce evidence-based resources on this article and leave the anecdotal stuff to individual webpages and/or popular newspaper articles. I am pleased we are in agreement about this. Ibsgroup (talk · contribs)

It's always a tedious discussion whether anecdotal evidence should be reported in Wikipedia articles. I think some of them are worthwhile mentioning, only as long as they have a verifiable support base amongst patients. But this verifiability creates a bottleneck - what is a reliable source to confirm this? You must - as a product of your position - know what types of remedies people use. Had you actually heard about the Van Vorous book? JFW | T@lk 19:10, 5 December 2005 (UTC)

Yes, I know Van Vorous personally. She started as a member of my organization. I believe Van Vorus has done a wonderful job at continuing to raise awareness. That aside, there are a lot of claims about easing symptoms of this illness. Without evidence that the individuals actually had IBS in the first place, you really have a hard time finding some benefit. As an organization we rely on clinical studies as the gold standard for deciding as to what helps and what may be anecdotal. As is stands today, there is no evidence which supports Van Vorous' approach. There may be something to it, but right now there is no evidence that diet, or a modification of diet, contributes, or eases, the symptoms of IBS. I believe we need to keep an open mind; however, we don't want to give false hope. Ibsgroup (talk · contribs) 16:02, 5 December 2005 (EST)

Hello - thought it might be helpful to step in here. I'm Van Vorous, and I'd like to make it clear that all of the information in both of my books (one of which actually contains an extensive interview with Ibsgroup, with whom I've always been on good terms - he has actually asked me to serve as the dietary expert on his "Ask the Expert" website section - so I'm surprised and saddened by his comments I've found here) is fully referenced with supporting clinical studies and research. You can simply check the footnotes if you're unaware of this. In terms of anecdotal evidence in support of my dietary information, you can certainly find a verifiable support base amongst patients. The Ibsgroup website alone has demonstrated this, as has the enormous IBS community (over 50,000 members, each one verifiable) at Helpforibs.com that has grown up around my dietary approach to managing IBS. In terms of clinical studies specific to the guidelines, it's a little disingenous for Ibsgroup to suggest that a clinical trial should predate my work, when my work already exists. There is in fact an ongoing clinical trial specific to my dietary guidelines (and prompted by the lead gastroenterologist's success with alleviating his own IBS symptoms through the dietary measures). The trial was designed by a biostatistician, has over 600 participants, is conducted by Dr. Noel Hershfield of Calgary, and is continuing as of 2006.

If you're looking for other anecdotal support of my work, consider: Novartis pharmaceuticals licensed dietary content and recipes from Eating for IBS; I've been interviewed about my dietary approach to IBS by Digestive Health and Nutrition magazine, the Boston Globe, the National Fibromyalgia Association, Today's Dietitian, Health.com, National Public Radio, and more. Doctors and dietitians throughout the US direct their patients to my books and website. The books themselves are the best-selling and best-reviewed books on IBS in the US - check amazon.com for a sample. My IBS information has been cited for excellence and used by the Dutch IBS Association, and presented to the European Associations for IBS by President Fien Stellingwerff Beintema in Paris, September 2003.

I would hope that these are all considered reliable sources to confirm that Eating for IBS has a verifiable (and significant) support base amongst patients. Hvan 22:36, 10 January 2006 (UTC)

• You state the case well for '"verifiable (and significant) support base amongst patients"', and that alone I think qualifies for commentary within WP. I am sure you recognise however that on its own this does not constitute scientific proof ('F-plan Diet' & 'Atkins Diet' both sold well with huge public interest and are thus important cultural phenomena to mention, but had little basis in fact that any Clinical Dietitician I have encountered would agree with).
• The success of the books is suggestive (but one could also wonder about good publisher marketing), but I do accept IBS groups have done useful work to look at dietary issues: a UK group were able to rubbish traditional medical advice of it always being a lack of dietary fibre (just great if suffering IBS induced diarrhoea !) and that 1-in-3 sufferers found caffeine had negative effects.
• As a doctor, whilst I might (and indeed do) suggest (for lack of any other approaches available to me) that patients might try some self-management measures, I would never absolutely insist/instruct/prescribe a course of action unless formal studies undertaken.
  • Therefore is most encouraging to learn about the study you mention. The inclusion of biostatistician hopefully will ensure a study undertaken in a manner than is both unbiased and, more importantly, with sufficient statistical power to provide some much needed answers. David Ruben ^Talk 02:22, 11 January 2006 (UTC)
    • Thank you, David. I appreciate your comments and agree with your points (except for good publisher marketing of the book - it was abysmal).Hvan 02:40, 11 January 2006 (UTC)

• Heather, publishing a study in a peer-reviewed journal would go a long way to gain support for all your hard work. Ibsgroup 16:34, 11 January 2006 (UTC)

Numerous studies demonstrate that food protiens can elicit immune system response. The challenge has always been to determine which foods to eliminate from the diet. The generic approach, which recommends that people avoid certain foods and emphasize other foods is logically flawed. Specific foods cause allergic response in specific people, but not in other people. Measuring the antibody response with immunoassay testing is the only way to definitively determine which foods a particular person reacts to. The danger in Van Vorous recommendations is that they encourage patients to emphasize foods (like soy) to which that particular person may be specifically allergic. Ibsgroup should read the literature which does support the fact that foods are absolutely involved in some IBS patients conditions and elimination of the right foods does have a (tested in blind and controlled studies) substantial and positive effect.

Alosetron, Cilansetron and Tegaserod

The European Union has not looked favorably on serotonin antagonists despite the dramatic relief that these medications have had with some IBS sufferers in very large clinical studies. This smells more like a political issue rather than a medical one. I don't believe it serves any purpose scaring patients from trying these type of medications if they can offer some relief. Ibsgroup 20:30, 7 January 2006 (UTC)

Kudos

Very nice article. I practice gastroenterology, so will be available for any technical questions. The recommendations are pleasantly mainstream and the tone balanced. I corrected a small bit on the initial screening section. S Holland, M.D. Kd4ttc 15:25, 11 January 2006 (UTC)

Hormone explanaton too simplistic

In India 2/3 of cases are men. The idea that hormones drive IBS is simplistic. That hormone changes can trigger IBS symptoms was discussed in the article. Kd4ttc 00:56, 13 January 2006 (UTC)

I concur. Worldwide, the epidemiology suggests that IBS is found equally in men and women. The theory is that more women in western civilization go to their doctor than men, hence the higher rate of diagnosis in western civilization. In Asia it's the opposite, ie: more men go to the doctor than women. Ibsgroup 23:49, 13 January 2006 (UTC)

I am interested in your Asia reference. I had always heard it was just in India that the numbers were reversed. do you have a pan-Asian reference? Kd4ttc 00:09, 14 January 2006 (UTC)

There seem to be many studies now coming out of Asia. This one eludes to the reverse pattern in Asia, PMID 15916618 Ibsgroup 19:38, 14 January 2006 (UTC)

Nice find. Not a journal I read on a regular basis. Kd4ttc 20:00, 14 January 2006 (UTC)

Therapy review

This is a review of treatment: PMID 16370407. Perhaps worth looking at. Jfdwolff 09:41, 13 January 2006 (UTC)

Diet

I'm having difficulty with this paragraph:

Many people, including physicians, have noted a connection between IBS and diet, and patient concerns reflect this. A 2005 study found that IBS patients are more interested in dietary education than any other topic (including medications and causes of IBS); they were most interested in learning about foods to avoid (Halpert & Drossman, 2005).

The study seems to be promoting more about misconceptions than anything. I'm not sure it really furthers anything in the diet section. Comments? Ibsgroup 19:48, 14 January 2006 (UTC)

Well, it taught me something if quoted correctly. It speaks to medical professionals to address diet isseues proactively. Drossman is a very good source on anything IBS related. He is very mainstream and did the original work on sexual abuse in IBS. It might be good to edit down some and move the paragraph to the beginning of the section to follow then to become an interesting introduction. You do the IBS so nicely and know wikipedia so well on that front I'll defer to your edits. Steve Kd4ttc 19:58, 14 January 2006 (UTC)

I am retracting the above. The article did NOT find they were most interested in dietary education. It really showed equal amount of interest in

Foods to avoid: 60%
Causes of IBS: 55%
Medications: 58%
Coping strategies: 56%
Psychological factors: 55%

I agree about the article being mostly about misconceptions. That is an interesting issue by itself. Kd4ttc 22:35, 14 January 2006 (UTC)

I think it's a good paper to reference since there are a lot of misconceptions about this illness. When I get sometime I'll rework that paragraph, move it to a more appropriate location, and properly reference it. Ibsgroup 23:23, 14 January 2006 (UTC)

This new study needs to be worked into the Diet section. I believe its conclusions provide some evidence that food sensitivity rather than the ingestion of "culprit foods" may explain a sufferers perception about diet being the cause of their symptoms:

Saito YA, Locke GR 3rd, Weaver AL, Zinsmeister AR, Talley NJ., (2005). Diet and functional gastrointestinal disorders: a population-based case-control study. Am J Gastroenterol. 2005 Dec;100(12):2743-8. PMID 16393229.

No differences were seen in the consumption of frequently suspected "culprit" foods between community residents with and without FGID symptoms. While symptoms may be due to food sensitivity rather than altered diet composition, the role of fat and perhaps norepinephrine and epinephrine in foods in gut symptoms needs to be studied further.

Ibsgroup 21:09, 28 January 2006 (UTC)

Complementary / Alternative Medicine

Since over half of IBS patients use CAM (study) does it make sense to have a separate section on this? There is a lot more to say about probiotics than what's currently mentioned, there is acupuncture and yoga, herbal medicine, etc. This might tie in nicely with expanded info about the importance of stress management for IBS, which is currently not addressed. Hvan 03:37, 15 January 2006 (UTC)

I wouldn't identify any particular therapy as CAM. That usually is a red flag for poorly studied approaches. Probiotics just started being studied and some patients do have a good response. I generally see patients get better without going to those very expensive products. I have seen 2 patients respond to Yoga. I have never seen herbals work. Had one lady come in with 20 CAM drugs. Got her off everything, she got better, and saved about $350 a month in drug costs. But definately don't call it cam. Get references from medical journals and the edits will be fine. Kd4ttc 04:49, 15 January 2006 (UTC)

I agree that it's kind of soon to truly support probiotics until further peer reviewed studies are completed. In terms of stress management, I think that just furthers the myth that IBS is all in sufferers heads. I believe stress is a factor of life and not necessarily correlated with IBS symptoms. I'm a strong supporter of traditional medicine so it would take a lot to convince me that CAM therapy is of any value in this article. Ibsgroup 16:31, 15 January 2006 (UTC)

Since it looks like we have a new Alternative Therapy section, that seems to be the place to add information on yoga, exercise, etc. I do think it's a little weird to lump all of these different treatments into the heading of "alternative" when they don't have much in common besides being non-pharmaceutical. But it will be nice to see additional treatment avenues included along with the acupuncture info, assuming that gets hashed out. Hvan 23 January 2006 (UTC)

A useful approach may be found in the thinking of Dr. Leo Galland, M.D. He has made a practice of complicated such cases, and has subsequently developed protocols that he has written about (search online for him, his Foundation for Integrated Medicine, and/or his articles on Leaky Gut Syndromes).

He breaks down such cases into a cycle of allergic reaction (usually dietary), malnutrition, bacterial disquilibrium, then the resultant strain on liver function and expression of relevant symptoms.

Based on patient lab tests, a physician can ascertain the likely systemic cause of the situation, then goes about an appropriate course of treatment--generally meaning a person first avoids their allergens, then rids themselves of internal problem microgrowth (sometimes with antibiotics), then builds back their immunity, with a basic rotation diet of natural unprocessed food supplemented with vitamins, minerals, amino acids, probiotics, and herbs.

(Galland's credentials include degrees from Harvard, New York University, and training at Bellevue Hospital.)

--Res_q68

Stress

Stress is one of the greatest triggers of IBS symptoms. That's not the same thing as saying that stress causes the underlying pathology of IBS, nor is it the same thing as saying that IBS is therefore all in someone's head. Stress is quite strongly correlated with symptoms - stress has a tremendous effect on the gut, and to ignore that makes for quite a glaring omission in this article. I agree quite strongly with you that IBS is not in someone's head, is not a psychological problem (see comments in new section below), and should never be portrayed in a manner that would convey that. It's not just wrong it's infuriating. I can understand that you're a strong supporter of traditional medicine, but personal preferences can't dictate the content of this page. The next person to come along might have little interest in traditional medicine, so relevant information outside that arena would be of value to them, if not to you. Hvan 19:56, 16 January 2006 (UTC)

When I talk about traditional medicine I'm implying evidence based medicine. There are lots of studies which discuss how maligned the illness is. That's enough to cause anyone psychological stress. I'm just not clear how this stress can be correlated with symptoms. Do you have specific studies that you can reference? Ibsgroup 21:52, 16 January 2006 (UTC)

I meant stress in general, from whatever source in a person's life (work stress, travel, lack of sleep, lack of exercise, etc.), can trigger symptoms. Not just stress from the burden of the illness itself. There are lots of interesting studies that correlate stress with IBS flares, and stress management practices with a decrease in symptoms. That's what I'd like to see added to this page. Hvan 23:01, 16 January 2006 (UTC)

Yes, I understood what you meant. I've added a blurb from an NIH Publication and referenced it. I think it captures this. Ibsgroup 13:18, 17 January 2006 (UTC)

Other

I added more to the pathogenesis including the increased visceral sensitivity and decreased somatic sensitivity seen in IBS patients as an issue regarding being in the head. I agree that including the studies on this being a gut problem needs better coverage. Kd4ttc 17:16, 15 January 2006 (UTC)

Do you have a reference for this?

Onset of IBS after an episode of enteritis has been described (partially after use of antibiotics). In these cases, a prolonged immune reaction may be the cause. Patients with this cause of IBS frequently resolve their IBS after 1 to 2 years. Ibsgroup 18:44, 15 January 2006 (UTC)

Now that I looked it up I need to modify my comment. I do remember seeing that factoid about the 1 to 2 year duration somewhere. There is some controversy on whether postinfectious has a better prognosis.

Marshall JK, Thabane M, James C, Borgaonkar M, Collins SM. Incidence of post-infectious irritable bowel syndrome (PI-IBS) following a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Am J Gastroenterol. 2003;98:S270. [Abstract #812] There continues to be major interest in postinfectious IBS. Marshall and colleagues[8] investigated an outbreak of acute gastroenteritis (that was attributed to a viral pathogen) and the subsequent development of IBS. This study documented a large foodborne outbreak of severe acute gastroenteritis at a meeting of the Canadian Society of Gastroenterology Nurses and Associates. The attendees were subsequently surveyed and followed-up. The study authors obtained a 71% response rate; 107 respondents (77%) described an acute enteric illness during the outbreak. Among those subjects who had enteric illness, the incidence rate of IBS at 3 months was 24%, although by 6 months the rate had dropped to 14%, compared with 3% and 11% among controls, respectively. from http://www.medscape.com/viewarticle/463420 Kd4ttc 00:58, 16 January 2006 (UTC)

I'm very familiar with this study as the town, where this outbreak occurred, is only about 2 1/2 hours from my home city. I believe your clarification helps although there might be some misunderstanding as to whether this is really IBS... but then again, this whole area of PI-IBS is kind of new territory. Ibsgroup 02:25, 16 January 2006 (UTC)

I see. As IBS is a syndrome if you have symptoms that fit, it's IBS. However, you are right in the sense that if the symptoms were only 3 to 6 months it doesn't fit Rome II criteria for IBS. Hmm. What to do. Let's see if there are other comments. As far as pathophysiology goes there are a few studies looking at intestinal permeability and likelyhood of getting post infectious IBS. This may be an important insight into pathgenesis. Kd4ttc 02:34, 16 January 2006 (UTC)

Rename "Psych" Section

I changed this to "brain-gut and other", as that seems more accurate than "psychological" to describe hypnotherapy, cognitive therapy, etc. Hvan 20:03, 16 January 2006 (UTC)

• Disagree - I think these approaches do operate via a psychological approach.
  • However whilst 'psychology' technically (and medically) accurate, IBS is a topic with past negative attitudes by some doctors of it being 'just psychosomatic'. Hence any word prefixed psycho- needs to be carefully introduced.
  • "Brain-Gut and other" is a horrible phrase, 'Neuronal-Bowel Interactions' might have been a more accurate way of describing what you intended (I dislike this only slightly less), but this is more a description of a heading within Pathophysiology rather than a class of treatment modalities (hence my preference for psychology).
• Hmmmm, tricky - perhaps seek opinions of the other two main contributors to this talk page for their opinions. David Ruben ^Talk 03:05, 17 January 2006 (UTC)
• I've seen a lot of literature with Brain-Gut so I'm not sure why this isn't an appropriate phrase. If anything, it may be confusing for someone who has never seen it before. Then again, Dr. Michael Gershon, who wrote The Second Brain refers to the Gut Brain in his book, although he is referring to serotonin more than a psychological component. I see what you are getting at. I guess I'm easy with either Brain-Gut or Psychological, although I'd lean towards Psychological with a sentence about the connection to Brain-Gut. Ibsgroup 13:31, 17 January 2006 (UTC)

Introduction section

I am reworking the intro. I corrected the clinical definition, but didn't want to get into Rome II criteria there. Kd4ttc 23:49, 17 February 2006 (UTC)

The introduction now reads "There are two forms, dependent on which symptom predominates: Lower abdominal pain IBS and Non-ulcer dyspepsia." I've never seen IBS defined anywhere as being non-ulcer dyspepsia. Is there a reference for this defintion someone can provide? Everything I've ever seen defines IBS as a lower abdominal problem that's either C, D, or A predominant. Hvan 21:04, 28 February 2006 (UTC)

I put NUD into IBS. It may be a stretch. Problem I didn't want to get into was another article on NUD. In the talks on difficult to manage IBS cases that I've attended NUD comes up often as a subtype of IBS. Calling IBS lower abdominal pain was probably not right. The cases of NUD tend not to have bowel habits associated but enough abdominal pain related to meals they make Rome II on symptoms associated with to make them really act like IBS. It may be best not to have NUD in the introduction, however, and address it separately. If that happens the lower abdominal pain would need to be dropped in the intro and a discussion of abdominal pain in IBS included with comments on IBS pain, distinguishing it from just cramps before BM's, and NUD. Kd4ttc 22:34, 28 February 2006 (UTC)

Does use of low-dose tricyclics as a pain-modifier (rather than as anti-depressant at higher doage) for NUD either suggest or refute its link to IBS. If NUD is distinct from IBS (as us humble non-specialists might define this), does this still have something to tell us about functional bowel disorders in general ? David Ruben ^Talk 22:44, 28 February 2006 (UTC)

I think I probably stirred up a can or worms by sticking NUD in the intro. There is actually a subgrouping of NUD into ulcer like vs dysmotility like. (pain in ulcer like, bloating in dysmotility like). If the tricyclics work, an open question, in NUD it is in the dysmotility like. I'll say the fact that you even asked the question speaks for the humble non-specialist is a pretty sharp cookie. You still taking new patients? They're lucky to have you! Steve Kd4ttc 02:26, 1 March 2006 (UTC) ps I'll read up on what experts are doing in categorizing NUD vis a vi IBS

Diagnosis section

I have corrected the diagnosis section to emphasize IBS as a diagnosis, not a diagnosis of exclusion. Kd4ttc 00:07, 18 February 2006 (UTC)

Isn't the 'diagnosis' primarily a 'confirmation of symptoms'? Obviously Doctors usually exclude other known causes, but fundamentally they are just giving a stamp of approval on the recognition of diharrea/constipation and some other factors via the Rome Criteria? I think the current section really makes the whole process seem entirely too empirical. Sarastro777 20:14, 21 February 2006 (UTC)

The diagnosis of IBS is to recognize the pertinent symptoms and exclude other diseases on history and physical exam. It has been shown that when rome II criteria are met and history and physical exam are negative followed by basic blood chemistries that there is a 98% confidence in the diagnosis. Thus the diagnostice evaluation does not have to go further. Diagnosis is not just a confirmation of symptoms. It is a recognition that the patient has IBS and thus has a predictable future, or what is called prognosis. What is wrong with empirical? Kd4ttc 17:35, 22 February 2006 (UTC)

Thanks for following up. I know this really is your area of expertiese.. and I mean that sincerely. I can follow the diagnostic approach, it makes sense.. but I think maybe what I was getting at can best be phrased by the questions I would ask..

What is the 98% confidence in, IBS? Then what is IBS? Just the Rome II w/o any other symptoms?

Essentially, isn't this saying if you have had diharrea/constipation etc then you get labeled with a syndrome that can predict with 98% accuracy that the symptoms will persist? Nothing wrong with empirical at all. Should we maybe point out then that medicine can't really confirm IBS other than identifying/confirming persistent symptoms without a known cause? I meant empirical in the sense there is not a known cause for which to test. Sarastro777 19:21, 22 February 2006 (UTC)

It is much more than that. A diagnosis is a classification which predicts a number of features of a case. For example, with chest pain brought on by exertion you are given the diagnosis angina pectoris. Further testing is needed to see if it is cardiac disease, and if so, a number of predictions can be made. In GI the diagnosis of IBS identifies a group of patients with abnormalities of GI motility. The patients have abnormalities of increased visceral sensitivity to stimulation. They do not have abnormalities found on further testing. They have a system that has abnormal serotonin metabolism and may respond to drugs that interact with the hydroxytryptophan receptors in the gut. They are likely to respond to smooth muscle relaxers. They do not have an increased rate of cancer. Many of them suffered sexual abuse as children. They do not respond to steroids, even though some studies suggest there are inflammatory changes in their instetines. If you have diarrhea but not IBS (not meet Rome II criteria) then you need a diarrhea evaluation which can involve extensive testing and 80% of those patients have an identifiable cause of the diarrhea. If you have constipation and not IBS then a lower GI workup appropriate to age is needed. So, the diagnosis of IBS triggers a workup different from either constipation or diarrhea, and it predicts a response to medication different from other problems associated with constipation or diarrhea. The confusion about IBS and the diagnosis issues may arise from some physicians not taking advantage of the predictive power of the diagnosis in directing the workup, or perhaps from the fact that the diagnostic criteria are so easily applied. Unfortunately a lot of IBS patients get short shrift in treatment and follow-up. There are some nuances on interpreting the symptoms and signs, but overall it is a diagnosis with very simple criteria. Another feature about using Rome II criteria to make the diagnosis of IBS is that the approach is validated. By that I mean you take a group of patients with GI complaints. Studies have shown that Rome II criteria correctly predict who will have a future course that looks like IBS. This was done by applying the Rome II criteria and then following the patients for 5 or more years and seeing what happened. A number os such studies have been done to validate the approach. For example if you just take constipation to mean IBS then you will find a lot of colon cancers in the group. If they make Rome II criteria you don't find colon cancer (at least not above the expected number for age and family history). A minor point - you don't label a patient with a syndrome, you recognize a syndrome in a patient and label it with a diagnosis. Kd4ttc 21:36, 22 February 2006 (UTC)

However, it is still just a group of symptoms that tend to cluster together. The fact is that IBS has a number of biochemical conditions that lead to the same symptoms. One of those is food allergies. Another is bacterial overgrowth. Another is celiac disease (gluten intolerance) - and there are others, some of which are not yet fully understood. But there is no single cause that explains all those people with IBS symptoms. IBS is not a truly definitive diagnosis in the way that tuburculosis or HIV/AIDS is a definitive diagnosis. It is a set of symptoms that share many of the same physiological conditions. Food allegies cause release of histamines, that cause swelling and neural effects (Wood, 2006 - Gut 2006;55;445-447). These effects are also caused by bacterial overgrowth, parasites, celiac disease, and other events that cause the immune system, the digestive system and the nervous system to 'run the program' that results in pain and diahhrea or constipation or both.

Bifidobacteria and other probiotics

A major problem with the probiotics is that the strains of the bacteria are usually not disclosed by the manufacturer. This is true for all the bacteria present. Even when tehy are specified it is not known what steps the manufacturer takes to prevent strain drift. The field really is a mess. I was rather kind in my comments about probiotics. That said, there is probably some truth hiding out there, but it will be hard to discerne given manufacturing and marketing practices of the industry. Kd4ttc 01:15, 20 February 2006 (UTC)

I suppose the problem for the manufacturers is, in part, that the various strains of bacteria can not be patented, and so fully disclosing the details of the contents ends up informing their competitors. Do you think either the manufacturers themselves, or advertising-standards or trading-standards know how much active bacteria is really left in the product after processing, storage in warehouses and then storage in consumers' fridges ? David Ruben ^Talk 04:03, 20 February 2006 (UTC)

Studies have shown few bacteria survive. However, there are studies that look at S. boulardi. That seems to be effective via surface receptors, so you might not even need viable bacteria. Of course, these questions wouldn't arise if the strains were described and the field were regulated, but that is a whole big issue unto itself. Kd4ttc 04:21, 20 February 2006 (UTC)

Problems with current edit on probiotics.

1) This section is "Alternative Therapy" and gave the take of Integrative Medicine, an "Alternative Therapy." This was edited so that now the conventional approach is given in the Alternative Therapy section.

2) There has been a loss in precision on the terminology of the specific strains of bacteria used. Lactobacillus was replaced with acidophilus. Acidophilus is not the only strain of Lactobacillus used in Integrative Medicine or in general. One example is "LGG" discovered by Gorbach and Goldin and now in wide usage.

I'd like to know why probiotic was limited in context (against the data outlined in the reference) to only two specific types, and why it was changed to share a 'conventional' viewpoint in the "Alternative Therapy" section? I see no longer see any reference to Integrative Medicine or Alternative Therapy whatsoever. I plan to edit this entry to make it germane to the topic heading. Sarastro777 20:09, 21 February 2006 (UTC)

Mediator called in without protocol

There is a comment above that a mediator was called in. I didn't see any formal request for mediation. The user that was claimed to be a mediator is a new user on Wikipedia. What was all that about? Kd4ttc 04:18, 20 February 2006 (UTC)

Would the mediator participate in the first place if he/she was "called in without protocol?" -- That's a rhetorical question 70.95.199.228 02:17, 22 February 2006 (UTC)

There are protocols for dispute resolution. It appears protocol was not followed. There was no request for comments, there was no comment section on this talk page, there was no reply to comments. This makes it unclear exactly what was mediated. Kd4ttc 17:28, 22 February 2006 (UTC)

Sarastro777 (aka 70.95.199.228): Could you elaborate on how the mediator Cameronian became involved on this talk page and the Acupuncture discussion? Kd4ttc 02:01, 23 February 2006 (UTC)

Yes... I read the Wikipedia policy pages on dispute resolution. From there, there is a link to the Mediation/Dispute Committee. Cameronian was listed as a member on that page. I left a message on his page in regard to the dispute. The other mediators had a similar setup with the exception of one that gave his private e-mail address. 70.95.199.228 07:11, 23 February 2006 (UTC)

An odd situation has arisen. The mediation did not follow Wikipedia protocol. No one else was afforded an opportunity to comment. The mediator's reply was not typical of the type of reply seen from a mediator. The chairman of the mediation committee notes that Cameronian is not a member of the committee, and the user has been advised to explain his actions or be blocked. The user Cameronian is not listed as a current or former member of the committee. Do you have a full URL for the page where you found him listed? BTW, You can set your browser to remember you on login. That way you will be automatically logged in. Kd4ttc 15:38, 23 February 2006 (UTC)

Not being a Mediator myself, I have idea what you are talking about. However, seeing that this user was listed on the mediation site as a mediator, i can't imagine the "administrator" has no idea of it. It would clearly be logged in the history of the contacts for the mediation comittee. I don't have a url and am considering the matter closed from my standpoint. If the "administrator" needs more information he can contact me directly. I will be verifying however he really is an administrator. This sounds awfully suspicious to me. The mediator stuff I went to was linked from [[5]] Sarastro777 17:46, 23 February 2006 (UTC)

I do not find Cameronian listed on any page. Can you point to any page where he is listed as being on any committee on Wikipedia? Kd4ttc 21:01, 23 February 2006 (UTC)

Well, this has taken an interesting turn. I was approached by Sastro to give an INFORMAL mediation on this page. I am a member of the AMA. Please see the page linked to by Sastro. This shows you how INFORMAL mediation can progress. I see you have gone to the leader of the mediation committee that I am NOT involved with. I suggest that you clear up this mess quickly.

My INFORMAL mediation did not require me to ask for discussion on the argument, as the 3RR had been broken, and I also judged the revisions to be a kind of vandalism, becuase they were removing useful content.

If any user would like to proceed with medation, please take it to a formal mediation committee. Thank You. Cameronian 10:33, 24 February 2006 (UTC)

Formal Mediation

Due to the comments above I now find it necessary to form a formal mediation on this article, in which all parties will be given a say on which content should be included in the article.

I ask that all parties are civil and proceed in the usual manner. I will first ask the disagreeing users to put their cases forward (Kd4ttc and Sarastro777). Once this has been completed, I will ask for comments from other users. Please remember to sign all comments with four tildes. Thank You. Cameronian 16:35, 24 February 2006 (UTC)

As part of the mediation process, I would like to state that my initial reason for not proceeding with formal mediation was that several rules had been broken, including the 3RR rule, which is in violation of Wikipedia policy. However, I now regognise the need for a formal mediation, so that this matter can be resolved once and for all. Cameronian 11:08, 25 February 2006 (UTC)

I would like to thank all parties involved in the mediation for their comments. I have now asked for another mediator to come in so the mediation can begin properly.Cameronian 19:44, 28 February 2006 (UTC)

Statement from Kd4ttc

Replies from the Chair of the Mediation Committee, User:Essjay, and from the coordinator of the Advocacy Group are pending. EssJay is out till Monday. I need results of their findings to properly formulate a statement for mediation. Kd4ttc 20:21, 24 February 2006 (UTC)

This matter has not been put up formally for a request for mediation. The above note from Cameronian suggests that he wishes to put it up for mediation. Cameronian has not actually taken part in this page and is not a party to Sarastro777 complaints, other than having taken her side some time ago when she put a comment on his talk page. Sarastro has entered comments in this section, so is acting as the complaining party. If she wihes this to go forward she will need to comply with protocols. Since Cameronian has stated that he has taken the position of supporting Sarastro777's position he may not take on the role of a mediator in formal mediation. Additionally, part of my concerns about this article include Cameronian's behavior, so he may not mediate, being involved in the dispute.

At this time I see two issues. The first is Cameronian's posts. Cameronian put himself to Sarastro and myself as a member of the Mediation/Dispute committee. He argued a few times that he was, but recently expressed the opinion he was tired at the time of those comments and had made an error. However, Sarastro777 had taken his comment to mean that he was an official mediator on Wikiepedia. He subsequently has explained that he was an informal mediator. While it is clear he was informal, he clearly was not functioning as a mediator. He did not seek others opinions about the matter and did not act in a neutral fashion. Cameronian has put himself on the list of Member Advocates, which, apparently, is where Sarastro777 found him (colmplicated by the unfortunate timing of his User Name change). However, he did not act as an advocate either in this matter as measured by the recommendations in the guide to Advocacy. Cameronian seems passionate about fighting for others. This is commendable. However, he has mixed roles of mediator, advocate, and peer. Cameronian should seek some mentoring for participation in the advocacy program and in future participation of disputes make clear the role he is playing.

The second issue are the complaints that Sarastro777 has raised. Sarastro777 has taken others' behavior to be inappropriate reverts. These reverts were done by a number of Users. As Cameronian put my user name here I will discuss the issues from my perspective. If the talk page and history are reviewed it is clear that it is a content dispute. The problem a number of other users have with her is that we disagree with the appropriateness of the web references she used to support the contention of Acupuncture in IBS. One page was a user who in a Web page on a health site said they felt better after acupuncture. The other reference was a web site by an acupuncture practioner that talked about what he did with acupuncture. In the talk page user David Ruben wrote a very nice piece about the level of evidence needed and the problems with using just one practitioners web page as a source to support the contention of the utility of Acupuncture in IBS. A number of users have made observations and recommendations on the matter above in #Bias and vandals associated with this article and #Acupuncture and IBS. I think everyone here recognizes that Sarastro777 is a new user (seemingly only since Feb 11, 2006) and have been tolerant of Sarastro777. However, now that a mediation request is entered it should be made clear that there are certain standards of behavior that are expected. First, the title of the talk section Bias and vandals associated with this article shows breach of the standard to assume good faith. Even by the end of the first post by the user the assumption was that the user was suffering "abuse of other people's intellectual/free time that are legitimately adding useful information on here only to have it removed based on some kind of bias/ego problem". The user's first entry on the talk page regarding the edits was a compliant about the process rather than using the talk page to understand what the situation was. Additional comments included "I think you just need to quit adding stuff for the sake of adding or changing unless you have something to say backed by some type of knowledge more than racist/bias notions of disinformation." Attacks on other editors accusing them of having racist/bias notions violated policy of assume good faith and policy to remain civil. Essentially we have a new user who has behaved at times inappropriately who provided edits that other editors thought did not meet standards of verifiability who is now complaining about people who disagree with them.

In reply to some additional substantive complaints raised by Sarastro777. I was accused of having a financial stake in giving advice here. I get no referrals based on Wikepedia. I have no financial interest in pharmaceutical companies. I do not do clinical trials. I was accused of private consultaiton with an arbitrator. That is not correct. I brought Cameronian's misrepresentation of his status to the attention of the Chair of the Mediation committee. I waited for that to be resolved before posting above regarding Cameronian's involvement. Cameronian noted breaking the 3 revert rule. I do not see that in the history.

In Sarastro777's case, I recommend that the user be mentored to understand wikipedia standards for verifiability, to remain civil, and to assume good faith. In her defense, I think that Cameronian missed an opportunity to work as her advocate in a mentoring role, and his misrepresentation of being part of the Mediation Committee gave Sarastro777 a false sense of legitimacy.

Kd4ttc 18:26, 28 February 2006 (UTC)

Stamement from Sarastro777

Adapted from original request for INFORMAL mediation.

Having trouble in the "Irritable Bowel Syndrome" article. The people lording over the page originally reverted my contribution (with the comment "revert") several times. On the discussion page they later admitted it was because I was "anon" and that "raises a red flag." I have added a section on "Alternative Treatment" and I have a Gastrointerologist (MD), threatening to delete it all again because there are not clinical trials referenced. The subject matter in question states what Acupuncture views as the cause of Irritable Bowel Syndrome, with a reference to a well-respected Acupuncturist addressing the matter. I am told that nothing I have to say can be included unless it can be "proven" and the threshold they give proven is that there must be a reference to a clinical trial. Since Acupuncture starts with some common knowledge, but then is tailored to the individual by the practitioner, there is not a reproduceable cure that can be blanketly applied to all IBS patients. This means there probably will never be a Western-style clinical trial to prove the efficacy of it in this regard (this is already well-documented in the Acupuncture article itself). Further how would a trial "prove" what Acupuncture as a discpline sees as a cause for something? This is merely a concensus among practitioners, not an argument as to whether it is right or wrong.

Further in the discussion above, you can see that I have been accused of providing no references. In fact, from the very beginning, I have added entries in the reference section of the article with each of my entries. This is clearly documented in the history of the article. I therefore suspect this was disingenuous reasoning to again delete my contributions.

As documented under the section heading "Bifidobacteria and other probiotics", I had put an entry in "Alternative Therapy" giving the viewpoint of Integrative Medicine via the advice of the ubiquitous and well-known specialist in the field, Dr. Andrew Weil. Weil was called a quack, my information was deleted, and a new entry with no reference was made giving the CONVENTIONAL viewpoint in Alternative Therapy. Now it is unclear why this data is in this section in the first place.

As is documented in the discussion of this page, there has been a lot of hostility regarding this article. I note several users airing similar complaints without the time or patience to pursue the matter, who have now simply left: Hvan, the contributor of the NPOV section, the contributor of the Treatment Advice section.

I am sorry that I even have to bring this up...but there is obviously a financial bias involved in this matter on behalf of those in dispute of my addition. One user has made it very well known on the discussion page and his own personal page that he is employed as a Gastrointerologist (MD). These individuals obviously make a living/are paid because they advocate and practice 'conventional' treatments. The trials being advocated are also usually paid for by pharmaceutical companies or other parties with large financial interest/means to fund such trials. This is fine, but not when it clouds our judgments and arguments, and makes it impossible for us to accept anything outside the realm of our background (this is not NPOV).

Secondly, another user involved in this dispute has used his own website as a reference, this is in violation of Wikipedia policy. This website also contains extensive commercial advertising for Pharmaceutical products. This user also lists that he has testified in front of the FDA to advocate for pharmaceutical products. Again, not a problem if we can remain unbiased..... but advocating (to the point of deleting other viewpoints) is not considered NPOV. In light of all the reverts, circular arguments, and superficial objections, this more than a little troubling when taken with these other facts.

Finally, apparently another party in this matter is now waiting on private consultation with an abritator in this matter? I have to say that certainly does not seem in keeping with protocol. If we have an objection, we have an objection... how is someone else going to tell us what our objection is? I am also suspicious of this and hope that we can remain 100% transparent in this process, so that it retains its integrity.

Thank you for your time. (Final edit) Sarastro777 17:48, 25 February 2006 (UTC)

Comments from other users

Ibsgroup

Dr. Holland et al - I have no interest in pursuing the IBS article any further at this time. We have both been victimized through name calling and bullying with wholly inaccurate information about each of us. If the IBS article starts including anecdotal information than it is of no use to the IBS sufferer as I believe it furthers the notion that IBS is a benign illness that can be remedied by baseless medicine. Those suffering from IBS deserve accurate information from reproducable reliable sources - not from an individual who has decided that we are all villains with hidden agendas. I believe you and I have conducted ourselves professionally with the best intentions for the Wiki IBS Article. Ibsgroup 20:45, 25 February 2006 (UTC)

Hvan

I would like to see alternative treatments addressed in this article - studies show that over half of IBS patients pursue these avenues, so there is certainly enough relevance and interest to warrant their inclusion. Where possible, citing clinical studies in support of these treatments is preferable, but it's also true that the lack of clinical studies alone doesn't mean a treatment should automatically be unmentionable. I'm not sure there should be a separate heading for "Alternative Treatments" instead of a comprehensive list of "Treatments" with various subheadings: diet, medications, brain-gut (which I think should be further broken out, as hypnotherapy alone deserves its own paragraph, at least), acupuncture, Ayurvedic, yoga, etc. It's a little unclear to me what makes a treatment "alternative", to the point that I don't know if it's even a meaningful title. Is anything that is not a drug therefore alternative? Acupuncture and Ayurvedic medicine are mainstream, not alternative, to billions of people worldwide. Herbal medicine and homeopathy are mainstream in the UK. There is certainly accurate and IBS-related information in all of these areas that could be contributed to this article, and I think this could only be beneficial to those who read it. Hvan 08:59, 27 February 2006 (UTC)

David Ruben

I agree topics should be included as well as mention if absence of supportive data (does not equate to no effect), but would disagree with "Herbal medicine and homeopathy are mainstream in the UK". They are certainly widely used (hence are notable and should be included in wikipedia), but are not part of mainstream conventional medicine as practised by the vast majority of UK Doctors, nor generally widely available on the NHS. Methods are only alternative until good science both proves effectiveness & shows how best to use a technique – it then tends to get incorporated into conventional western medicine (hence accupuncture for joint pain used in Chronic Pain clinics, willow bark as a painkiller led to aspirin). That said I think the various alternative approaches do need to be included in this article but:

• Definitely in a separate section - most doctors will feel very unhappy if there is no distinction, similarly whilst herbal has some clear uses (purified peppermint oil in capsules is a conventional prescription product in UK), whilst homeopathy raises all sorts of problems that I am sure are covered in the relevant article.
• To be included, all that is required is that a non-trivial number of alternative practitioners would use their technique for this particular condition. Hence whilst I am aware accupuncture is used for joint pains, I am ignorant about whether a few/some/many would apply the technique for IBS - I think an editor should educate us conventionalists in the talk page whether this is so, but I would not demand to have WP:Cite to prove this (in same way I can't easily find a reference to say GPs see cases of sore throats every day, yet we all know that to be true and can find research on how they treat such cases)
• Quite separate is whether there is evidence to support an effectiveness of a method better than placebo. But I should point out:
  • A widely used technique, is notable precisely because it is widely used whether or not it works. Therefore it must (under WP policy) be included in an article (with neutral language to describe the lack evidence)
  • A lack of evidence is not proof of ineffectiveness, just that the relevant studies are difficult to do or just simply have not been done yet.
  • Even if a technique is stated as being "ineffective", very often this is being disingenuous and POV, for what is really meant is that the technique performs as well as placebo. Given that placebo is often as much as 30% of some conventional treatments, this might indicate a highly cost-efficient way of providing significant safe benefit to a large number of patients. I agree us doctors don't tend to think like this, but we all recognise paracetamol helping for a headache within a few minutes, yet know that blood levels are not really established for at least 30minutes. I don't wish to appear to be stating that I believe all alternatives only have placebo effect, just that even this is a recognition of some useful benefit from which one hopes research might show yet further usefulness. Much of conventional medicine is the art of applying science, and its distinction from alternative is (I hope) a willingness to subject itself to research and change accordingly (e.g. reduction in the use of routine antibiotics for sore throats).
• Various alternative approaches have differing levels of scientific foundation to their method of action (herbs often potent chemicals, accupuncture perhaps working via pain-gate model, homeopathy has some difficulties here), but these are issues for which wikipedia should outline the nature of the debates in the relevant articles (wikipedia is not of course a soapbox to carry out the arguments themselves). As far as this IBS topic is concerned, items get added if notable whether through common usage, compelling well performed research or historical fact; an item may fall within one or more reason but not all. So mention the conventional approach as we might expect any children's encyclopaedia to do, add in greater technical details, discussion on the researched treatments (e.g. just how well do they work - certainly anti-spasmodics drugs only are helpful in a minority of patients), then show how much better is wikipedia's breadth by mentioning additional information. One might start with non-drug measures such as counselling, to dietary manipulation, progressing to the less-widely-accepted/contentious alternatives - which ones, whether any specific nuance of approach for IBS that differs from the standard approach discussed in the specific method's article, indicate where the support comes from (e.g. traditional use in China for TCM/accupuncture, last 100 years (or whatever) for homeopathy in the West), then mention whether there are good studies looking into the method and finally what cautious (as all good scientists should be) conclusions can be currently drawn. Wikipedia is not a manual of Evidence Based Medicine (although, alternativists, this is always appreciated to cite & verify information), but an encyclopaedia discussing the world and us imperfect creatures (so, conventionalists, we can’t always find objective proof of that which makes us feel better).

• As an example, I think User: 70.95.199.228. Sarastro777 comment, on 17 February 2006, about TCM having a different perspective of IBS and so _targeting treatment at the symptoms is quite fascinating and needs inclusion in its own section. This new users comments were well expressed and actually made me want to read more about the viewpoint, yet I don’t believe in Qi, and am sceptical about accupuncture’s role in IBS (yet will advocate in chronic pain – so I’m mixed in my views). I can support such an inclusion on the basis of TCM being notable (1/4 population is chinese and TCM is certainly notable in China) and is quite distinct with whether I personally subscribe to the perspective or feel evidence does/does not support TCM herbalism or accupuncture. Sure the section should also mention whether studies back up the approach, but that does not negate its inclusion. Sarastro777 seems articulate & sensible enough, in my own limited conversations, to formulate a neutral description of the perspective, a de facto account of accupuncture’s use for this condition and recognise that “evidence” is currently sadly less than it might be. I’m sure us conventionalists can help guide a new user who has shown willingness to engage in discussion (having come up a learning curve as we all did when 1st joining wikipedia to jump into articles we felt strongly about) and ensure application of NPOV policy does not allow any wild sweeping fanciful statements to last for long, but tone down any wild claims on just anecdotal evidence to something neutrally phrased and acceptable to all.

Does the above help mediate an agreeable framework to help develop this article ? David Ruben ^Talk 22:33, 28 February 2006 (UTC)

I think this: "Wikipedia is not a manual of Evidence Based Medicine (although, alternativists, this is always appreciated to cite & verify information), but an encyclopaedia discussing the world and us imperfect creatures (so, conventionalists, we can’t always find objective proof of that which makes us feel better)" pretty much says it all for me. Thank you. Hvan 02:11, 1 March 2006 (UTC)

While Sarastro777 would disagree, I think the other editors were not unhappy with acupuncture in the article. They just wanted to see some references other than a single practitioner's web site where he said he used it. If there are more than a handful of places that use acupuncture on IBS then I'd expect something somewhere would be quotable. I actually thought your initial framework about how to characterize evidence was a very nice service to this new user, but I was disappointed that it wasn't really addressed. I also liked the comment on TCM having a symptom driven approach. This doesn't mean the sources to meet verifiability cannot be found, but they may be found wiht searches other than IBS. While a lack of evidence not proof of ineffectivness, lack of evidence does not meet the criteria of verifiability. All this said, I'd like to see Sarastro777 do the legwork on the references. If it is real there has to be more than a handful of references. Sarastro777 will have to expect that an acupuncture section will also include comments that acupuncture has not seemed to work in IBS when formally studied, but can be relieved that other users will not require Sarastro777 to make those edits. Kd4ttc 23:15, 28 February 2006 (UTC)

Dispute Regarding Claims Protocol Was Not Followed

Some statements have been made regarding what I have said, what was said to me, and what I thought -- by someone other than myself without knowledge of the matter. I would like to clarify.

"Cameronian put himself to Sarastro and myself as a member of the Mediation/Dispute committee."

No he did not.

However, Sarastro777 had taken his comment to mean that he was an official mediator on Wikiepedia.

No I did not.

Cameronian has put himself on the list of Member Advocates, which, apparently, is where Sarastro777 found him (colmplicated by the unfortunate timing of his User Name change).

All of my contact with Cameronian was through the name Cameronian. He was not found on the "Member Advocates" list, which is why he did not serve in that capacity.

As has been stated Cameronian is an disinterested party here. He serves as an informal mediator, a standard precursor to seeking formal mediation. No protocol has been broken here. Any user can do this. Please also do not put words into my mouth, interpret my thoughts, or convey events on my behalf. I am more than capable of doing this myself. Sarastro777 19:23, 28 February 2006 (UTC)

In reply: Cameronian wrote "I am a member of the Mediation/Dispute Committee, for the record, I have qualifications in Biology." Sarastro777 in a post above wrote "Also, the ruling from the mediator has come down. I share it below and will be adding it into a comment in my edit." and then followed it with the decision rendered by Cameronian. Your contact with Cameronian was noted in the dispute section of his user page. You had said that you found Cameronian through the mediation page when you wrote above "Yes... I read the Wikipedia policy pages on dispute resolution. From there, there is a link to the Mediation/Dispute Committee. Cameronian was listed as a member on that page. I left a message on his page in regard to the dispute. The other mediators had a similar setup with the exception of one that gave his private e-mail address. 70.95.199.228 07:11, 23 February 2006 (UTC)". I appreciate your further input. There are contradictions evident in the record, however. Sarastra777, I was giving you the benefit of the doubt on how you contacted Cameronian and took you replies at face value to my questions. The comment that other mediators had similar page set-ups shows that you were working with a group following protocols, and with Cameronian not having been on the mediator page the only conclusion I can draw is that he was on the Advacates page where you found him. Coming out with the conclusion that the mediator had ruled was a statement that accorded a level of authority upon the pronouncement that on further investigation proved unsupported.

Perhaps you should look over the protocol for requesting formal mediation to see if the steps have yet been taken that are required before requesting a formal mediation. Kd4ttc 23:03, 28 February 2006 (UTC)

We don't need to turn this discussion page into endless bickering between the two of us. Your voluminous quotes from Cameronian distract from my point -- which was to say *I* did not think or say what you were quoting me as saying. This is known in legal circles as hearsay. Out of basic fairness and to insure that mischaracterization is not taking place, it is generally in poor taste to speak on behalf of somebody else, especially if they themselves are available to weigh in on a matter.

As revealed from your carefully excerpted quotations, nowhere was the word "binding" stated or implied. It would seem to me, that perhaps your "conclusions" are wrong rather than my memory. I think we can just leave it at that. In the future, please do not speak on my behalf.. that is a reasonable enough request. Thank you. Sarastro777 23:55, 28 February 2006 (UTC)

The problems with Cameronian's behavior are separate from your issues regarding edits and reversions of your contributions. I am not using memory. I am quoting from the record. As you are new here I suspect you did not recognize a redirect. Complaining regarding hearsay is simple enough. You can look up the quotes. I cut and pasted from your posts so as not to make mistakes in quoting you. You put the word binding in quotes above, by which I presume that you are now saying that the mediation was not binding. That is a different tune from when you announced the mediator's (Cameronean's) decision.

I think it is important that you consider the advice given to you to learn wikipedia culture and get some more references on acupuncture. The problem you had was not with me alone. I came into this when I saw your complaint that you were unfairly shut out. My initial interest was to let you understand the motivations of the Users that disagreed with you. The hope was that you, a new and apparently interested user, would learn from the advice offered when you were thinking about abanding the community. I think my comments to your inappropriatly titled section on bias and vandals are still valid. A number of editors were involved in editing and reverting your work. It would be appropriate for you to seek a third opinion from some user you have seen edits from and ask him to review the above proceedings. You can then consider a request for comments. I suspect that my appraisal in this mediation bit that cameroneon set up will hold sway regarding the way I characterized your edits and others responses. The structure that Cameroneon set up is really more of a request for comment than mediation. Recently I saw that Cameronian left the Advocacy group and now is participating in the Mediation Cabal, where he has referred this case. Formal mediation requires that there has been an impasse and that the dispute has gone through an RfC. (That is the detail I thought you might learn if you read the formal mediation article). The mediation Cabal, is informal. Someone from there may come by. It is odd, though that it is being put up by Cameronean, since it is in essence your complaint. I tried but could not find confirmation of Cameronean's assertion that anyone could put up something for mediation. Anyone can weigh in on, but not put up for mediation, disputes they are not part of.

If there is no interest by the Mediation Cabal on this then I recommend that the acupuncture bit is opened up for general editing in a few days. Kd4ttc 02:10, 1 March 2006 (UTC)

Apparently I was not clear or there is some difficulty with comprehension here...

"However, Sarastro777 had taken his comment to mean that he was an official mediator on Wikiepedia."

THAT is hearsay. Please don't do it. End of story.

I never said the mediation was binding/official/etc. It is in quotes, because you have made that your "conclusion" to make me the bad guy in this. It is absolutely clear in the record. Again, I can't see why you keep arguing this.... everyone can read what was said and what was not.

The problem is not my understanding of Wikipedia or Cameronian. My problem is clearly stated in the statement for mediation. It stands on its own. Again, we are already addressing these in the proper areas. Lets keep this confined.

In terms of your claims that protocol was not followed... it has already been made clear there are no requirements to request unofficial mediation. Anything more are you conclusions, opinions, etc and really do not support the point that protocol was not followed. Perhaps this is not the proper place to share that? Sarastro777 02:46, 1 March 2006 (UTC)

I had given you the benefit of the doubt on your having thought the mediation was authoritative. Had you been misled about the status of the mediation being official I could conclude that your posting about the mediators decision having come down was due to misunderstanding of the mediators role. You have made it very clear now that you knew at the time that Cameronians involvement was informal and non-binding. You should have worded post as one where you had sought advice from a third party. Your posting regarding results of mediation was misleading because you knew it was nothing official yet you summarized it in a way as if it were. Kd4ttc 15:37, 1 March 2006 (UTC)

I concur. I was misled by the tone and language used. I believe the climate would be healthier here with less rhetoric and more suitable behavior and self control. Ibsgroup 18:30, 2 March 2006 (UTC)

Since nothing to this regard was stated explicitly, then we must assume that perhaps there was a comprehension problem with you two. This would be the policy, as there is a " standard to assume good faith" -- meaning that since I did not say it was official, then you should not assume otherwise, especially when it furthers your own argument (objectivity bias).

What is interesting about this, is whether or not he is official, the entire point of what he said has been completely overlooked. We know he did not even have to progress the matter to the point of discussion because of the serious policy violations that had taken place. Isn't this really the point? I am highly suspect that if he had come with a different opinion I would be having this same discussion with you two. In my opinion, whether or not you two correctly perceived his status, the content of his judgment itself has been entirely ignored. Sarastro 22:55, 2 March 2006 (UTC)

From my standpoint the reason that Cameronian's conclusion was not persuasive is that he didn't contact the parties involved to see what they thought before coming to a conclusion. Additionally, there was no explanation of how he considered any evidence. Since there was no input from other parties and the reason for the conclusion was not given there was not any real content to his decision. In fact, it was such a goofy statment that I investigated futher and found that he messed up an informal mediation by deciding to take a side in the argument and that he was first advertised on the Advocate Page, where he shouldn't have even been engaging in attempting mediation in the first place! There is a guideline on mediation on Wikipedia that discusses these things and notes that a situation can get way out of hand when a mediator takes a side in a dispute. Looks like history repeated itself. As far as assume good faith - I do. I assumed that you erred when you made a statement that the mediator made an official. I also think you are arguing because you think you are right, rather than arguing for the purpose of disrupting other users. In that way I am assuming good faith. If I didn't think you were showing good faith I would have called for an RfC followed by a request to have you blocked days ago. Kd4ttc 02:55, 3 March 2006 (UTC)

Now you are going to have me blocked for wanting this page to be inclusive? and making a good faith effort at discussion? Do you really have the ability to have someone "blocked?" Based on the behavior on the main article, I would think you would have alreay done it. Sarastro777 03:56, 3 March 2006 (UTC)

Please reread my last paragraph and reconsider. You misread the last sentence. Kd4ttc 04:50, 3 March 2006 (UTC)

Disregard of Legitimate Informal Mediation

This entire thing has taken a troubling turn.

An independent third-party informal mediator was contacted in regard to the ongoing dispute on this page. Namely the continual reverts of my edits by two people, obstruction of adding material/alternative therapy info to the IBS article, and destructive edits of material in the alternative therapy section.

The mediator ruled that the material in question could stay and egregious violations of Wikipedia policy had been taking place (why at this stage input from other parties was not required, nor requested).

Instead of simply abiding by or at least considering this INDEPENDENT viewpoint voluntarily, the people involved have decided to attack the process and continue their behavior.

Steps to Dispute Resolution (http://en.wikipedia.org/wiki/Wikipedia:Resolving_disputes)

1) Avoidance

a)First my material was deleted with no reason.

b)Then the reason was that I did not have sources. (Check history to see there have always been references to the material in question)

c)Then the reason was that my sources did not agree with other people's sources. Rather than 'agree to disagree' the agenda became to argue my source did not "prove" anything and again delete my contributions

d)Deletion of my material/sources resumed and destructive edits began to remove my edits to reveal the "MD perspective" in lieu of rather than IN ADDITION to.

2) Talk to other parties involved

a)Pages of discussion resulted in no agreement. An "Alternative Therapy" section was added by myself as an attempt at compromise. This did not progress the matter at any level.

3) Further Dispute Resolution 3.1 INFORMAL MEDIATION

a) This was done and the informal mediator ruled that egregious violations of policy were taking place. Rather than accept this, disputors have distracted from the matter by arguing protocol has not been followed.

The other options on the chain cannot be implemented because we cannot agree on a truce

For disputes over the content of an article, if you have not agreed to a truce before this point, you should do so now. This allows others to fairly consider the issue without the confusion of ongoing edits, which are likely to aggravate the dispute. If an edit war persists and a truce is not feasible, request that the page be protected to allow the process to move forward.

Nobody (Third Parties, Surveys, etc) can issue comment on the material in question, because it has been removed by two people...continually. This is why we are not supposed to remove or delete other material.. as stated repeatedly by my quotations from policy, by common sense, and by the informal mediator.

Now we are at an impasse. I would be interested to understand how the opposing two parties (IBSGroup - who had previously stated he was going away, and KDTTC) in this matter propose to proceed in light of the steps above, understanding that continued deletions/censorship is not an option and we cannot proceed to the next step so long as this continues. Sarastro777 22:04, 2 March 2006 (UTC)

Well, that sort of sounds reasonable. What happened, though, is that the entry on the Mediation Cabal for this article was changed by Cameronian to Withdrawn. I took that to mean that there was no longer an interest in mediation. It looks like you are confusing informal mediation and formal arbitration. Mediators, informal or formal, work to bring sides together and do not make rulings. Rulings come from arbitration. Now, if you are really that interested in having something done you should put in a request for comment. Note, though, that the only edit that has happened to the Alternative treatment section was the elimination of the internal invisible paragraph that had the comment the section was in mediation. Kd4ttc 01:11, 3 March 2006 (UTC)

By the way, as long as you are getting all in a snit about policy and egregious violations, take a look at the 3 revert rule that you are in a huff about. Wikipedia:Three-revert_rule That rule applies only to an individual and only if the 3 reverts are on the same day. It specifically does not apply to groups. The fact that there were 2 editors (ibsgroup & jfdwolf) who made one change per day over 4 days shows that the revert rule was not broken. It shows two people disagreed with you. Then your first posting on the talk page was to make complaints rather than to try to learn what's going on. I think the editors have been very nice to you. You are new around here and there wasn't even a complaint about you doing most of your initial complaints as an anon. We were happy you went and got a real user name. How about talking to User:Davidruben? He has posted some very nice long pieces to give you some direction. He seems very nice, and when he sees some sort of edit war he always posts a nice, reasonable piece to look at the big picture. He made some very nice teaching points about the quality of evidence. You might, for example, see if there might be some formal academy of acupuncture somewhere, perhaps, just maybe, try a google search on something, like, oh "American academy of acupuncture" and see if there are any links to any association of acupuncture practioners that might have a page on, say, acupuncture in IBS or somethink like that. Then point David to what you think makes a nice edit somewhere with a reasonable reference, and see where that takes you. Kd4ttc 02:34, 3 March 2006 (UTC)

First there is no confusion about anything. I quoted exactly in order the dispute resolution policy, and this has been followed precisely. I think where there is confusion is that by pretending this was not followed, it will somehow allow us to continue to delete material and feel validated.

If you read the very first paragraph of the page I linked, what is in bold? I'm not a snit about anything, but you don't seem to understand that it is against policy to delete things. You observe that I complained, maybe because policy was broken repeatedly and my entries were reverted? This seems to really mystify you. People don't like to be censored..especially when the people doing it apparently don't understand the reasoning behind the policies.

You say it is not a problem that I am new around here, but you have mentioned it in absolutely every paragraph you have posted. It was also said that an "anon" raises a "red flag." It does not take a GE class in Psychology to see that this is threatening. As I said, I realize you feel you have a vested interest in the article by virtue of the time you have put into it. Unfortunately, this does not give you anymore authority than any other user.

David Ruben, and Heather V. have both backed adding the section.. and neither has reiterated your misconception about what constitutes a valid source, and what does not. The informal mediator also backed this.

I don't see why this has to be so adversarial. Do you not want an inclusive article? Your name (and IBSGroup) are mentioned nowhere as the "gotos" for approvals on additions. I am trying to work out a truce here so that we can have the 'alternative' stuff added, commented on by third parties and put up for a poll. Instead you respond with this, and go delete another item out of the acupuncture section. Coincedentally you did not bother to read the source again. The garbage diagnosis is a direct quote from the page, which is why I restored it. The reasoning for its deletion is entirely invalid.

It is becoming quickly obvious that we are not looking for a resolution. I'm really willing to work with you guys on this. This has been a legitimate effort at discussion. Working at, is not the same as you dictating your viewpoint and everyone else following it though. Can we have a little good faith, are you going to agree to the truce proposal so that we don't have to go to binding arbitration? Sarastro777 03:47, 3 March 2006 (UTC)

Resignation

As you may have noticed, I have made the decision to leave Wikipedia over this case. It seems that certain people have a disregard for others on this Encyclopedia.

As far as I am aware, I followed protocol at all times, and instead of accepting this, people decided to attack the process I had followed, with disregard for the fairness I had approached this subject with.

I did not find this acceptable at all, and realise that the system does not work.

It has also been clear throughout this process that User:Kd4ttc has been breaking the NPOV rule, by not allowing Alternative Treatments to be listed in this article. I find alternative treatments to have at least some benefit to users (even if only putting them in a better frame of mind), and from a medical ethics POV it seems that the user was trying to withhold genuine information from the public (although this would not have been directly for personal gain; the user is obviously involved with a traditional branch of medicine).

I hope that this issue will be resolved soon, and I hope that all of you feel able to work together to create a good article soon.

Cameronian 19:08, 7 March 2006 (UTC)

Cameronian: I was happy to see you leave. You came into a talk that was ongoing and gave misleading information to a new user. You made incorrect conclusions about breaking the 3 revert rule, caused another use to complain that there were clear violations of policy, and you are unfamiliar with dispute resolution. You couldn't even figure out if you were to be in the user advocacy group or the mediation cabal. You now make unfounded accusations about another user breaking "the NPOV rule" about allowing alternative treatments in this article when I was one of the people writing about alternative treatment. Please do stay missing. Kd4ttc 22:40, 7 March 2006 (UTC)

Reply: 1. The user asked me to give her information. 2. The information I gave was not misleading. As an advocate, it was my duty to tell the user whether I agreed with her edits or not - and if you look in the history you will see that the revert rule was broken (I don't think it was by you, and I am not accusing you of this), and also reversions were made after the user has asked you to discuss this on the talk page (again, this is against Wikipedia policy). 3. I am not unfamiliar with dispute resolution. 4. I was aware which group I was in, I merely made a one-word error, in my haste, and this was resolved, your argument was not valid. 5. I was actually SUPPORTING your edits on alternative treatment, I was stating that I believed OTHER users had broken the NOPV rule by dismissing alternative therapy. 6. Sarastro may not have been new. She was previously an IP user, she could have been here for years prior to registering.

It seems there have been a few misunderstandings along the way here. Before leaving completely, I would like to clear them up. - These posted by Cameronian but unsigned

After her asking you, you pronounced she was correct in her edits. No counseling was given that the complaint against here was that she had lousy references. You have stated several times that you were moderating, not working as an advocate. Now you assert you were working as an advocate, but you didn't follow the recommendations appropriate to that role. The 3 revert rules was not broken as it was two users who did one revert per day over 4 days. User Fasten told you were incorrect in your approach and recommended you read up on guide to mediation. You mistake saying you were a mediation committee is not what I referred to. It was moving into the Member Advocate group then into the mediation cabal. That your poor advice was to a longer term user rather than a newbie is no defense. Kd4ttc 21:04, 8 March 2006 (UTC)

If it is not a defense then you should not be using it as a starting argument. I was, firstly an advocate, and then decided that I would prefer to mediate. This move actually had nothing to do with this case. Cameronian 15:11, 9 March 2006 (UTC)

My concern over Sarastro777 being new was that she went to someone who presumable had experience dealing with disputes and got bad advice. Initially she found you on the advocacy page. You then shoot back you are on a mediation committee, you posted on my page and other places you were mediating. Only after the chair of the Mediation Committee called you on it you didn't change your assertion. Then you fell back on explaining you were doing informal mediation. Only recently, after this was all cleared up, do you start to talk about having been an advocate. This sort of flip flopping of roles was not appropriate. When the coordinator of the mediation cabal told you that you were incorrect in your attempts at both advocacy and mediation you should have recognized you had made mistakes and learned from them. I gather you are not resigning. Kd4ttc 19:02, 9 March 2006 (UTC)

I will be when this issue is resolved. 84.69.127.123 19:08, 10 March 2006 (UTC)

Alternative Treatment

The introduction sentence said Some TCM practitioners consider IBS to be a gargage diagnosis. I haven't seen a reference that any TCM practitioners think so so I deleted it. Kd4ttc 03:03, 3 March 2006 (UTC)

That's a verbatim quotation from the reference page, (not even any of teh detail pages off the left links). Please read the reference before deleting other people's data Sarastro777 03:35, 3 March 2006 (UTC)

Well no wonder you don't see a reference. It was deleted. Isn't that convenient? I guess this is the problem with destructive edits... people lose track of information Sarastro777 03:51, 3 March 2006 (UTC)

I couldn't find it. Where in the page was it? Kd4ttc 03:56, 3 March 2006 (UTC)

Well, let's see... if we go in the history and look at.. http://en.wikipedia.org/w/index.php?title=Irritable_bowel_syndrome&oldid=39948857

And follow the last reference (which I added).. there it is. This would be from the entry: 00:48, 17 February 2006

It would be the first sentence of the third paragraph from the main page, not from the corresponding links on the left.

Sarastro777 04:00, 3 March 2006 (UTC)

I'll be more specific: The quote said that some western medical practitioners call it a garbage diagnosis. The TCM editors don't recognize it, he said. There are sereral editors that have felt that the reference is not very good for reasonse previously stated. Please find a better acupuncture reference. Kd4ttc 04:04, 3 March 2006 (UTC)

I understand how you have read it... BUT let me quote...

IBS has become a bit of a "garbage diagnosis" for some medical practitioners.

He's saying that "Medical Practitioners" use it as a "garbage diagnosis" ... which is different than medical practitioners calling it a garbage diagnosis. HE is calling it that... it's implied in the syntax of his sentence.

Now beyond that, I think the problem again is a moving _target.

You deleted the piece because you said it was not referenced. It was.

Now you changed your reasoning to question the validity of the source. Which is it? It seems pretty clear you deleted it because of the first, not the second?

Sarastro777 04:12, 3 March 2006 (UTC)

And later it says that TCM practioners reject the diagnosis in the first place. You have an odd reading of it. He asserted that for "some medical practioners" (not TCM) they have consider it a garbage diagnosis. Here is how it could be stated: "One practioner of TCM asserts on his website that IBS has become a bit of a "garbage diagnosis" for some medical practitioners". That would be an accurate description of the situation. It is not true that "Some practitioners of Traditional Chinese Medicine have called the diagnosis of 'Irritable Bowel Syndrome a 'garbage diagnosis'" You only have this one guy, and he didn't say it. Did you try the google search I suggested? Kd4ttc 04:26, 3 March 2006 (UTC)

I can't diagram the sentence on here, because there are not the graphical tools to do it. If we break it down.. "IBS has become a bit of a garbage diagnosis" -- ok but who does the diagnosing? "medical practitioners." He is criticizing their diagnosis, not saying the western practitioners themselves call it a garbage diagnosis.

I like your edit better... clearly they all think it is a garbage diagnosis, or they would use the diagnosis themselves... but strictly speaking, only this one source is being quoted (obviously you can't quote more than one person unless they speak precisely the same). I'm putting in your version. Thanks! Sarastro777 05:21, 3 March 2006 (UTC)

Suggestions

I quite liked reading recent version. Can I suggest a few points:

1. "Probiotics are generally accepted to be potentially beneficial strains of bacteria and yeast, often found in the human gut." I'm not quite sure how to read & interpret this. Are we to accept that they are strains commonly found in the human gut (yes), that they are non-harmful strains (yes). The term "probiotics" refers to supplements rather than a classification system of gut bacteria, so I have a problem with the implication of "beneficial". This of course means non-harmful (on which I agree) but also implies a useful therapeutic effect (which I would be doubtful, certainly many believe this, there is some research as you quote, but its not totally proven yet). We don't need to completely duplicate the Probiotic article here of course, but a slight rephrasing might be more specific and neutral. eg "Probiotic supplements, of certain strains of bacteria and yeast often found in the human gut, may be potentially beneficial."
2. "One research study has shown a clear link between the ingestion of Lactobacillus plantarum LP299V and sufferers of Irritable Bowel Syndrome who reported resolution of their abdominal pain.". I find this rather wordy in relationship to the overall size of the article and a more importantly an awkward sentence. The article is about IBS, so presumably any study cited is applicable to people with the condition. Also "research", "study", "shown" seems duplication given "reported". "clear" is presumably dependant upon the statistical results, p values etc and the overall robustness of the study design. A more succinct sentence might be "Lactobacillus plantarum LP299V has been reported to resolve abdominal pain."
3. "B. infantis 35625, a strain of Bifidiobacteria " Does the "B." stand for "bifidiobacterium" or for "bacterium" ? The press release reference used did not elaborate, but a quick search shows it is the former, so I suggest a neater "Bifidiobacterium infantis 35625"
4. The press release would be better replaced by a reference to the final published research paper. I had a quick look (here at PubMed search) but obviously was going about this the wrong way (probiotics effects on mice was hardly what I sought). Do you have the reference ?
5. Link the two sentences together: "Lactobacillus plantarum LP299V has been reported to resolve abdominal pain and Bifidiobacterium infantis 35625 in normalizing bowel movement frequency."
6. "This discipline continues to find increasingly widespread acceptance in the United States, and it is estimated that nearly 8.7 million Americans have sought its benefits. " I appreciate, given recent discussion on this article, the need to perhaps emphasise accupuncture being notable and therefore worthy of being included in this article. However I thought the current version tends to be too much of an explanation for accupuncture as a whole, rather an elaboration of its role in IBS. I'm happy with the first clause, the second is about all-use of accupuncture rather than IBS-use. The second clause might be better replaced by some activity measure of accupuncture in IBS (e.g. "x% of accupuncture sessions are for IBS").
   1. PS not being American myself, "8.7 million" fails to mean much (what is USA population and when was 8.7m determined, given population increased from 281m in 2000 to 299m in 2006 - see stats on United States), so a percentage figure or ratio is more meaningful to the wider English speaking wikipedia (e.g. 2.9%, or 1 in 34, of all Americans).
7. "Preclinical studies have documented acupuncture's effects," Again is this in regard to accupuncture as a whole or a specific assessment in the case of IBS?
8. Finally references really should be linked to the relevant statement in the text - this is a fault of course with the whole current article, not just the Alternative Treatment section. There have been a number of footnote/reference systems used in wikipedia over time, the current favourite is the < ref name="xxx" > ...details... < /ref > with references then flushed into the relevant section with just < references / >. Given the multiple recent edits over this section, and my own suggestions, I'll await comments - but I'm happy to do this for all the references in the article.

You are obviously currently actively working in this section, so I've put my suggestions here rather than directly as article edits. David Ruben ^Talk 12:02, 3 March 2006 (UTC)

Thank you David. Your suggestions are very well thought out. If we are going to refer to B. infantis 35625 in this section, then perhaps move the reference to Quigley (2005) from the Brain-Gut and other section to this one. I agree that Probiotics are generally accepted to be potentially beneficial strains of bacteria and yeast, often found in the human gut. One research study has shown a clear link between the ingestion of Lactobacillus plantarum LP299V and sufferers of Irritable Bowel Syndrome who reported resolution of their abdominal pain is pretty awkward and I'm not quite sure what it is meant to imply. I also would not go so far as to use language such as clear link as it has yet to be reproduced nor determined exactly which bacteria may be beneficial. Personally I have used probiotics for my IBS for almost 10 years and it hasn't been any of those strains mentioned; however, I do believe the discussion about probiotics needs to be included in some form. Separately, I maintain that Dr. Weil is not a authoritative reference for this article due to the lack of any personal research in the area and that the reference is a commercial publication, ie: Prevention Magazine. There are far better centers including UNC Center for Functional GI & Motility Disorders, MayoClinic, John Hopkins, and Cleveland Clinic to name a few that do research, that may be considered as a reference. Ibsgroup 14:22, 3 March 2006 (UTC)

Thank you David and IBSGroup for the suggestions. I will be working to implement them asap. RE: Weil.. maybe it would help to explain why he is there in the first place. I'm trying to give the perspective of "Integrative Medicine." Weil has written 9 best-selling books on the subject, is on tv, radio, and is the founder and director of the Program on Integrative Medicine at the University of Arizona (which he founded in 1994). Because of the millions of people that are interested in him, he provides a "notable perspective", namely that of Integrative Medicine. As the Director of PIM, he is also influencing an entire generation of MD's studying under his office. This certainly warrants mention. As far as the source itself, it is only an interview... as long as we are not disputing that the interview itself took place, I don't see why the location of the webhost in particular is of great concern. Maybe we can augment this, but since the PIM has just been around a little over 10 years, and there not yet nearly as many other practitioners as even something like chiropractics, there just might not be the material we wish there was. I think the way it is introduced, through the context of probiotics, something he is vocal on is very appropriate, and the reference serves as making the statements on integrative medicine "verifiable" (i.e. "integrative medicine thinks this")

On the Quigley reference, my only question might be that with the way it is worded.. it is coupling "poor bacterial balance" with the "probiotics"... this combination doesn't really tie in with just probiotics by themselves which are being discussed. Also, unclear if this one study (which appears not to focus mainly on probiotics in the first place) would add notable new information to the 'alternative' perspectives already being discussed. Sarastro777 18:15, 3 March 2006 (UTC)

Regarding probiotics: This is really a marketing term. Bacteria are little chemical factories that happen to reproduce by binary fission. They have no brain or soul (we think). That they are either good or bad is a gross oversimplification. Bacteria are what they are. They have surface structures that can bind to other surfaces, like us. They make chemicals that signal other bacteria and antibiotics that inhibit other bacteria. They exist alone or only in colonies, with or without tolerance to oxygen. It should give everyone pause to consider that for germ-free mice given a mix of 5 species of bacteria they will reconstiture their normal flora over time. However, if only one species of any of these "good" bacteria are innoculated into the gut the mouse will die of overwhelming sepsis. The inability to culture 80% of the flora of the human gut shows we know little of their metabolic requirements and suggests that many bacteria can only exist in mixed colonies. The whole idea that there are good versus bad is probably untrue. There isn't even a test that you can do to say good vs bad. Until recently there were not even any clinical trials to suggest that orally administered bacteria were of any use. Trials that have started to come out are really represent our early learning about what these strains do. I urge caution in any comment suggesting enthusiasm for these expensive and generally unregulated products seen on the market today. Kd4ttc 22:31, 3 March 2006 (UTC)

Reference-Citations mess

The references were a total mess:

• Lead author & date of publication errors
• Harvard references (i.e. name & date given in brackets) without any citation details given in the reference section.
• Some entries in reference section seem difficult to identify where they are referred to it the main text.

So I have:

• Wherever possible, expanded the citation details (using PubMed tool - see Method of adding javascript bookmarklet here).
• Converted all the references to Cite:Ref system
• Tried to give a meaningful reference name to each one (I generally use "Journal Year - Author"), it then becomes apparent where a citation is duplicated (Which Cite:Ref allows for) and this also allows for several different references by the same author to be clearly distinguished.
• Tried to place each reference at the correct location in the text (my deep apologies if any are misplaced - especially difficult were those giving the Rome criteria and NIH statements re accupuncture).
• Placed references after punctuation.
• Used {{Fact}} tags for any Harvard references for which no citation details were given.

I truely hope this helps. David Ruben ^Talk 02:39, 4 April 2006 (UTC)

I've had a go at the missing citation details - some seem wrong lead author or year to be able to decide precisely which paper implied (?my misunderstanding). This seems to leave "(IFFGD, 2004)" in Diet section - not sure what this stands for, so unable to lookup on PubMed. David Ruben ^Talk 03:12, 4 April 2006 (UTC)

Thanks for the help Davidruben! I think that if the actual reference cannot be identified via a citation given in the article, the citation should be removed. I think that not doing so might give a false sense of reliability for certain information in the article. What do others think? JeffreyN 15:58, 24 April 2007 (UTC)

Elaborate on Symptoms?

It might be worth listing a few more possible symptoms of IBS, as they have been known to vary quite a bit, ranging from jelly legs (accompanying intermittent pain) to headaches.

Did you know...?

There is a song by the Arrogant Worms about IBS. Seriously. :D `- DragonSparke 01:12, 3 August 2006 (UTC)

External links, once more

See this entry also.

• I removed 2 links to Project IBS - Laboratory of Elie D. Al-Chaer for the Study of Pain, don't have a clue what that could be doing here...
• The www.ibsnetwork.org.uk explanation was kinda over the top, made it a little shorter.
• http://www.ibs-relief.co.uk is from Boehringer-Ingelheim, so I removed it.
• http://www.mymultiplesclerosis.co.uk/ibs.html was like a blog?

Maybe this page could benefit from a warning message like this:

<!--- Do not add external links to this article without discussing it in the {{PAGENAME}} discussion page. Because of continued spamming, links without prior discussion are very likely to be reverted rapidly.--->

--Steven Fruitsmaak | Talk 23:46, 3 August 2006 (UTC)

re http://www.scottish-ibs.org.uk/ 1st Scottish IBS Support Group - Self help support groupd for IBS sufferers in Scotland

I do not understand why people see a link to a non-profit self help group's website as SPAM, the wiki is there to provide information to its viewers and I feel strongly that this link provides usefull information for sufferers. Varitekweb 23:44, 10 December 2006 (UTC)

Well I thought the wiki was an open platform of community edited content providing a usefull source of information to its readers, but I have discovered that this is most certainly not the case but it is in fact a haven for an egotistical unwelcoming clique of people who have a firm belief that whatever they say is the gospel and only they have the right to add and remove content as they see fit. The wiki was a very good idea but as with most things of this nature it has fallen into the hands of egotists who will bring about its downfall. good luck in your insular little world Varitekweb 01:02, 11 December 2006 (UTC)

The above is a voliation of WP:Assume good faith about the other editors - AGF is not optional.

Like all wikis, wikipedia operates under a group of mutually agreed policies and guidelines. These have been previously pointed out in the edit summary (see this edit) that directed to explanation of policy at User talk:82.41.193.43. I have again removed the external link:

• Firstly that website seems to be non-functioning.
• Secondly Wikipedia is NOT a directory listing of support sites & forums (however good they might be). External links are generally only to sources of a greater amount of information than that which the article should have at Featured article level of quality - See WP:EL for guidelines.

In general when writing an encyclopaedia, "add content rather than external links". David Ruben ^Talk 01:37, 11 December 2006 (UTC)

Functional Brain Gut Research Group

There's a sentence mentioning The Functional Brain-Gut Research Group of the Rome Committees. Actually, the Rome II committees and the Functional Brain Gut Research Group are two different entities, although the latter's membership often overlaps with that of the Rome committees. The FBG is an organization of professionals which defines itself as a "non-profit, international, democratic group of researchers and clinicians who are opinion leaders in the functional gastrointestinal (GI) disorders, including dyspepsia and the irritable bowel syndrome (IBS)".

--Eguirald 16:26, 8 August 2006 (UTC)

Eguirald, your additions and modifications to this article, and that of the Rome Process, are outstanding. When I wrote the sentence about the FBG and Rome II for this article I was using language that I borrowed from the actual Rome II book. I am actually a member of the FBG so I am aware of the distinction of the two organizations. I was challenged with that sentence and wanted to convey that they were separate entities yet the language from the book made this inference which perhaps I did not convey correctly. Please feel free to modify the sentence to better convey how or by whom the Rome II diagnostic criteria was developed.

-- Ibsgroup 02:57, 13 August 2006 (UTC)

Dairy: Good or bad?

In the paragraph for treatment of IBS, under Diet, there's a section that says "substituting soy or rice products for dairy... can [help] to lessen the symptoms of IBS", but then right afterwards it says "Foods and beverages to be avoided or minimized include... dairy (even when there is no lactose intolerance)". So should dairy be avoided or not? Zaroou 19:57, 14 September 2006 (UTC)

I am not aware of any evidence that avoiding dairy will reduce the symptoms of IBS. For someone who has both IBS + lactose intolerance then one could see how dairy products may further aggrevate the IBS symptoms (related to PMID 15370685). That being said, it seems the section that you are referring to likely needs some better clarity. Ibsgroup 20:42, 8 October 2006 (UTC)

There's no risk to avoiding all dairy products, and many people with IBS find that it is a major trigger. There are several studies on this. One to check is Gut. 1989 Aug;30(8):1099-104 where the single most commonly identified food trigger was dairy. Hvan 22:37, 19 October 2006 (UTC)

GA Review

In reviewing the article according the Good Article Criteria, I have to decline the article's GA nomination at this time for concerns listed below. For comparison of medical articles written about an illness, I referenced the style of the FA quality of the articles on Chagas disease, Cystic fibrosis, Tuberculosis and Down syndrome to assist in this review.
1. It is well written. - Needs Improvement

• I'm not a fan of the title of the Brain-gut and other section. It seems rather "unencyclopedic" and out of place slang. I was screened for IBS and while the doctor talked about psychological factors that were involved, I cannot see her using the description of these as "Brain-gut" factors.
• The section The Rome Process reads a lot like a "How to diagnosis guide" and I am of particular concern about the first person "we" used in the line "Because of the characteristic symptom instability, we prefer the terms IBS with constipation and IBS with diarrhea instead of constipation- and diarrhea-predominant IBS.". I suspect that the line is a quote from the sources but as it is currently presented it comes across as first person OR. I would recommend the editors visit that and rewrite as appropriate
• Similar to the "how to" sentiment is the line in the Treatment section seemingly giving advice to a doctor. "One of the most important therapeutic measures is reassuring the patient that they have no fatal or otherwise threatening disease, as this is the major concern of patients seeking medical help." and then later the survey results given "The respondents indicated that they wanted their physician to be available via phone or e-mail following a visit (80%), have the ability to listen (80%), and provide hope (73%) and support (63%)". The first part of the survey results deals with the article subject of IBS. This additional add on seems to be for the benefit of the doctor instead of the reader.
• The above also ties into a general concern about the "over technical" aspects of the article that seemed to be written for the expert instead of simply being written by an expert. I think it is important to keep focus on the _targeted readership being largely lay person or the curious versus writing the article geared towards Medical professions. I'm sure for the medical profession there are more professional sources on IBS that they would go to before a Wikipedia article. The type of reader that is going to come here are going to be more average folks who would go to a site WedMD for info. The article does make excellent use of wiki-links and explaining some of the medical jargon for the layperson, it just the general tone that I'm concern with.

2. It is factually accurate and verifiable. - Weak Pass

• Overall the article is well reference and makes ample use of reliable sources.
• I understand and appreciate that there are not concrete answers on what causes IBS or even the best way to treat it. However I am concern at the amount of speculation that is included in the article without clear attribution to the particular study or medical journal that promotes that speculation and that is why this is listed as a weak pass. I have tagged some of the areas that caused the most concern.

3. It is broad in its coverage. - Needs Improvement

• I think coverage of the criteria listed in the Diagnosis section is a bit lean. For instance, the Manning Criteria gets a 2 line mention and doesn't even describe what the criteria is.
• I also think more details in Epidemiology section would be a plus.
• I was surprise at the absence of a history section--at least in regards to medical awareness and treatment of IBS. It is mentioned that it was at one point an exclusion diagnosis and then recently has become it's own diagnosis. The impression given by the article is that IBS is a modern Western concept but I suspect that is not the case.
• There is quite a bit mentioned about the pharmaceutical medicine that is available for IBS treatment but there is scant mention of the some of the alternative medicines that an average reader would see at their local Vitamin World. It's been awhile but I remember being offered 4-5 different things (in addition to Lactobacillus) that supposedly would help. Given the emerging popularity of homeopathic treatments, I would think that there are reliable sources out there to comment on these alternative treatments.

4. It follows the neutral point of view policy - Pass

• The article takes a very clinical tone in its presentation of its subject and passes the NPOV criteria. It could use more details on Alternative Medicine but the absence doesn't equate to a violation of NPOV and the current treatment of the content is presented in a way that is neither hostile nor sympathetic.

5. It is stable - Pass

• There has been some substantial changes in the past week [6] but not enough to compromise the overall stability of the article.

6. It contains images, where possible, to illustrate the topic. - Pass

• The article currently doesn't have any images (and to a degree, that is a good thing :p ) and a literal interpretation of Criteria 6 indicates that an absence of images doesn't prevent GA promotion. However, I evaluate this criteria on whether or not an article needs images in order for the reader to fully understand the topic. In that evaluation, the article passes this criteria. Images are helpful though and I encourage the editors to be mindful of opportunities in particular with charts-like IBS occurrence in the populace, etc.

Overall, I think this article is well done and on good footing to eventually achieve GA status. I want to thank the editors of this article for their hardwork and effort that has gone into the article and getting it to this point. I encourage the editors to consider resubmitting for GA consideration once these concerns have been addressed. If you have any questions, feel free to contact me. Agne 00:18, 17 October 2006 (UTC)

NPOV/Relevancy

"Many sufferers of IBS seek relief from Acupuncture, a component of Traditional Chinese Medicine and a discipline representing some of the oldest and most used medical procedures in the world. This discipline continues to find increasingly widespread acceptance in the United States, and it is estimated that nearly 8.7 million Americans have sought its benefits [33]. One practitioner of Tradtional Chinese Medicine asserts that IBS has become a bit of a "garbage diagnosis" for some medical practitioners. Traditional Chinese Medicine does not recognize the Western diagnosis of IBS per se, as the named condition has no definitive single test for diagnosis, clear cause, or cure. Traditional Chinese Medicine approaches IBS on an individual symptom-by-symptom basis, rather than recognizing a standard "IBS" diagnosis, which then warrants a blanket "IBS" treatment [34]. The concept of Qi is important in Acupuncture, as obstructions to its proper flow throughout the body are considered a contributing factor to illness. Details of the specific mechanisms through which Qi function remain as yet unexplained by Western scientific methods. According to the National Institutes of Health, "Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine that is commonly practiced in the United States." [35]."

How is "Qi" important to the topic, IBS? How does the number of people using acupuncture matter to the article? Why are there subtle jabs at western medicine, again with no relevance to IBS? (e.g. "Details of the specific mechanisms through which Qi function remain as yet unexplained by Western scientific methods.") I was thinking of simply deleting the irrelevancies but I thought it best to discuss this on talk beforehand. --Wooty  Woot? | contribs 20:06, 31 October 2006 (UTC)

Improvements needed

• There are no references to empiric studies in the treatment section. I am concerned that a number of treatments proposed on this page are not supported by evidence, specifically the use of narcotics and sedatives. ANother example is the sentence 'Low dosage of tricyclic and SSRI antidepressants have shown to be the most widely prescribed medications for helping to relieve symptoms of visceral sensitivity (pain) and diarrhea or constipation respectively.' This is note referenced, and even if referenced, I do not think we should use precedence rather than empiric study as a arbitrator of worth.
  • I added a reference to antispasmodics.
  • I added references to serotonin agonists including SSRIs.
• All of my reading says tegaserod is selective partial agonist at the 5-HT4 receptor - not an antagonist as stated on this page.

Badgettrg 19:24, 7 November 2006 (UTC)

I agree needs some citations (or at least an indication of which reference source). However remember that there are two aspects to inclusion in treatment sections in wikipedia (and it is not wikipedias role to arbitrate or decide what is best, but report on the external world)

1. Is a particular treatment used, whether effective or not. Remember what counts is to report on the real world (we do not have WP:SPOV but WP:NPOV) - hence increased fibre that I was taught as a medical student should be mentioned even if quite obvious will exacerbate diarrhoea-predominant IBS, likewise I have no problem including relaxation techniques, accupuncture, herbal medical etc - they are all used.
2. Quite separate is whether any particular methods actual works. Such claims in wikipedia clearly must have citation from reliable sources to verify the fact. Much of "traditional" conventional medicine with regards to IBS management lacks Evidence Based Medicine, likewise much of alternative medicine lacks evidence.

Its not question of "precedence rather than empiric study" but having both - precedence does count but claims of effectiveness I agree needs empiric study. David Ruben ^Talk 19:52, 7 November 2006 (UTC)

Anagram comment

An ip included:

"Irritable bowel syndrome" is an anagram of "O, my terrible drains below".

Should we put this in a trivia section?--Steven Fruitsmaak (Reply) 22:50, 12 November 2006 (UTC)

Probable causes: Bacterial parasites and the problem with testing !

This is information transfered from the giardia discussion group.

This is original research however it is hoped someone out there has already done research to this effect.

There appears a simple problem with testing for bacterial infections. Specifically the disease like IBS, OR Crohns and Collitis, may in fact be caused by some undetected bacteria. Some research has already detected a MAP bacteria, however the 'trickle down' of this cause may be hampered.

You must excuse the incompleteness of this post, ie no other references, but my own research, with a Dr. Lower has confirmed that 'testing' for giardia is not 100% accruate.

That is the test for giardia must be repeated 4 to 5 times, that is 4 - 5 times before you can rule out the possibility of Giardia.

So the problem is that people suffering from 'the symptoms' get tested once, and if the test is negative, falsely believe that they do not have giardia.

Now the problem is compounded because chronic intestinal problems can lead to a variety of symptoms that we label as 'diseases'.

I will be following up by doing research on the City of Walkerton, referred to as the Walkerton Tragedy whereby animal waste entered the water supply, and going by visual reports on TV, some of the individuals developed MS type symptoms; so the potential of neurological symptoms is very likely.

Question is why is this not being researched and exposed ?

There must be a wealth of knowledge to be gained by this unfortunate experience.

--Son of Maryann Rosso and Arthur Natale Squitti 16:17, 25 November 2006 (UTC)

"Of the 675 people who submitted stool samples, 57% submitted samples that tested negative for both E. coli and Campylobacter. A negative test result does not necessarily mean the person was not infected. It might also mean that (1) the person had stopped or was intermittently shedding the bacteria, (2) the culture was not tested before the bacteria died, (3) the culture was mishandled, or (4) another pathogen was responsible for the symptoms. Accordingly, it is possible that some or all of the people who tested negative were in fact infected, or had previously been infected."

From the Wakerton report it becomes evident that this important problem with testing has escaped the attention of the general public and some doctors.

My personal research suggests a great deal of suffering is being played out in our society due to this flaw in testing.

I hope someone who has the time will input this information into the appropriate spots.. Thanks

--Son of Maryann Rosso and Arthur Natale Squitti 16:26, 25 November 2006 (UTC)

You should understand that the treatment for a bacterial infection of the intestinal system usually involves three things.

1. A wide spectrum antibiotics. Pharmaceutical or natural.

2. Fiber.

3. Probiotics.

Any intestinal abnormality suggests that the intestinal gut flora has been corrupted and must be replaced.

I hope that those of you who have time to look this over and find sources for this, may, if they feel it is warranted add this to the listing on IBS OR CROHNS.

--Son of Maryann Rosso and Arthur Natale Squitti 01:02, 27 November 2006 (UTC)

If you can find sources yourself, add it to the article. --Wooty Woot? contribs 01:17, 27 November 2006 (UTC)

Okay ! (I have someone in the hospital and my other work is a little on the heavy side...)

--Son of Maryann Rosso and Arthur Natale Squitti 21:55, 27 November 2006 (UTC)

You need to find sources from medical journals, or some such. People you meet do not qualify as reliable sources. I'd look this up in pubmed or something but I really don't have the time. Sorry. --Wooty Woot? contribs 22:31, 27 November 2006 (UTC)

This 'disease' will be used as a model for how 'the system' profits from treating symptoms, and not treating the cause; that would be too simple, too effective and costly in terms of lost revenue.

--Son of Maryann Rosso and Arthur Natale Squitti 23:22, 29 November 2006 (UTC)

THE OVERLOOKED RELATIONSHIP BETWEEN INFECTIOUS DISEASES AND MENTAL SYMPTOMS

[http://www.personalconsult.com/articles/infectionsandmentalsymptoms.html THE OVERLOOKED RELATIONSHIP BETWEEN INFECTIOUS DISEASES AND MENTAL SYMPTOMS]

Seems that a very probable cause of mental illness symptoms, has been overlooked.

The key word parasites.

If you examine the symptoms associated with some mental illnesses like schizophrenia, they include intestinal disorders that may be wrongly associated with emotional disorders.

The simple logic is that the corruption of the intestinal system by a bacterial infection, or by toxins created by these 'parasites' results in symptoms that reflect a mental illness, but with an organic cause.

--Son of Maryann Rosso and Arthur Natale Squitti 23:21, 30 November 2006 (UTC)

This is not a page to discuss possible causes of the disease in the article. --Wooty Woot? contribs 21:17, 2 December 2006 (UTC)

There is certainly some evidence to support bacterial overgrowth, but parasites causing IBS-like symptoms are pretty rare in the Western world. JFW | T@lk 22:31, 5 April 2007 (UTC)

The assumption you make is a great problem. 1. Western World people travel to third world countries. 2. Western World people are exposed to contaminated water, ie camping, and ie errors of treatment. ie Giardia in Thunder Bay spring water because beaver were not trapped in the spring fed lake. 3. Pets

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 17:11, 3 August 2007 (UTC)

Developments

The role of protease enzyme activity has been emphasised. Are we really getting desperate for an explanation of IBS or what?[7] JFW | T@lk 23:24, 7 March 2007 (UTC)

Spastic Bowel Syndrome

Just so everyone knows (I don't think I have to tell people this do I?) but I am making a redirect for Spastic Bowel Syndrome to this article, as it was a page request/potential article but seeing as its very associated with this article (after googling) I decided to do the redirect. Cya.petze 10:36, 3 April 2007 (UTC)

Parasite section in pathopysiology

There was a section under Pathophysiology regarding "Parasites". I wanted to make a note here that I removed the section for the following reasons:

• A significant portion was copied directly from [8]
• The section does not explain how parasites are/could be related to IBS; only a description of parasites and their effects is given; but questions such as "How is inflammation and tissue destruction related parasites a possible cause of IBS?" are not addressed; I realize the answer to this question may be obvious to some, BUT it still must be addressed (see other sections in pathophysiology)
• There was two paragraphs in the section they dealt more with bacteria (not parasites), one of which was badly written; I think as this section deals with parasites, bacteria should only be mentioned when relevant

If you wish to re-add the section, I ask that you please address these issues. I feel that if not addressed (esp. in regard to the second point above), then the section should not be added again.

Thanks, JeffreyN 15:49, 24 April 2007 (UTC)

Parasites can cause IBS.

(this is my personal research, however you should find other sourcs to back this up...(I don't have the time...))

Parasites can cause IBS, by creating toxins that trigger an intestinal reaction to remove them. THIS IS KEY !!!!

That is why Imodium works so well in some cases.

The treatment for parasites.

1. Wide spectrum anti-biotic, ie erthomycin, or garlic cloves, etc. 2. Fiber, helps remove the material. 3. Probiotics, you want to renourish the intestinal flora with the proper stuff. IE yogurt, saurkraut.

The treatment of IBS is difficult due to the problem of an overgrowth of bad bacteria...etc...

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 17:16, 24 May 2007 (UTC)

Symptoms of parasites.

Since the body reacts by the noted symptoms a secondary impact occurs.

Many of the necessary vitamins and minerals are expelled, or non absorbed. With such deficiencies you can develop a variety of other symptoms, including nervous disorders, we call diseases, ie MS.

A lack of proper nutrients NOT BEING ABSORBED can create a variety bio chemical disorders, ie depression, anxiety, .....

The logic of parasites is important to understand. Not only the infection, but more important the toxins...

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 17:35, 24 May 2007 (UTC)

Marijuana

Marijuana is used to treat IBS. AThousandYoung 06:22, 30 May 2007 (UTC)

LOGIC might suggest, although not prove, that if IBS is caused by the bodies natural reaction to toxins caused by a 'parasite', then the use of marijuana would serve to reduce the natual reaction...and eliminate the symptoms.

It is interesting to note that Imodium works much the same. While it is not an antibiotic, its ability to neutralize the bodies natural reaction to a toxin, renders some the symptoms of IBS neutralized. This however does not treat the underlying cause. --Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 18:48, 31 May 2007 (UTC)

Imodium causes mild spasm of the smooth muscle and delays peristalsis. The hell it doesn't treat the underlying cause. If you knew the exact underlying cause you'd probably win the Nobel Prize. Incidentally, most IBS is not due to any parasite at all. If that were the case, it would not be a syndrome but a parasitic enteritis. JFW | T@lk 15:55, 15 July 2007 (UTC)

No, it is not. It is abused by some who, when stoned, are less bothered by their IBS. JFW | T@lk 15:55, 15 July 2007 (UTC)

Neuropsychology

Gastroenteritis can set off IBS is people with particular character/behavioural traits. This may be worth including: doi:10.1136/gut.2006.108811 JFW | T@lk 15:55, 15 July 2007 (UTC)

Faulty bacterial testing may be the problem !

Faulty bacterial testing may be the problem !

IBS, like similar disease, IBD, Crohns, and related diseases like MS, some cancers, schizophrenia, Mania, and others may be based on an overlooked simple cause; faulty bacterial testing for a common bacteria like giardia.

Original research suggests that some specialists and doctors are not aware that giardia requires some 4-5 negative tests to prove that you do not have it.

A failure to understand this simple truth, may cause the problem sovling process to overlook this as a possible cause, by making the false assumption that one negative test excludes this as a cause.

Simple Herbal Cures

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 22:45, 19 July 2007 (UTC)

Your claim about Giardia testing needs a source. See WP:V#Sources for the kinds of things that Wikipedia accepts. A link to a private web site, electroherbalism.com, is far from adequate to back up a medical claim. We need to see journal references. Your comment above mentions 'original research'. Original research is not allowed in Wikipedia articles; see WP:OR. EdJohnston 15:24, 26 July 2007 (UTC)

For the sake of the encylopedia, and the truth of the matter, I am providing a lead; hopefully someone with high speed internet can find that important reference. Anyway, perhaps the encyclopedia could provide a listing for probable, or upcoming original research, that might indicate an important break; ie cause and cure.

I am hoping to write my book, and if I keep up trying to find another source for my original research I will not be able to complete my book, but hopefully provide someone with an important bit of information to treat their problems.

Lead: Giardia most common parasite sometimes requires 4-5 negative tests to determine. If the false conclusion is reached than we have overlooked the most probable and likely cause....

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 13:51, 28 July 2007 (UTC)

Revert was done in good faith

I reverted your section on Gardia in good faith. The site you have is selling all kinds of things from all kinds of places. Please assume good faith. --CrohnieGal^Talk 21:44, 25 July 2007 (UTC)

That is an interesting comment, every doctor, every medical school is 'selling' pharmaceutical drugs and their related 'paradigms' so should we ignore their 'suggestions', especially when they cannot pinpoint a cause and cure, but merely refer you to tests, and drugs to maintain their business... ?

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 14:24, 27 July 2007 (UTC)

The herbal companies will sell you a 'cure' based on a cause, and then by telling you what the actual product is, you can grow it yourself and not have to buy their product, try doing t hat with a pharmaceutical snake oil salesman product ?

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 14:26, 27 July 2007 (UTC)

Commercial sites are not allowed here as sources, except in articles about themselves, which is often hard to do. You should read the policy on external links before adding anymore links.

BTW, I would recommend that you change your signature. You are exposing yourself and your parents to danger by revealing their identities. There are nutcases here who could misuse that information. -- Fyslee/talk 14:36, 27 July 2007 (UTC)

I appreciate the information. Recently a medical trade journal magazine had most of its staff quit because they could not print the truth.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 14:55, 28 July 2007 (UTC)

Anti-biotic treatment ?

If one of the causes of IBS is a bacterial overgrowth or infection, how come no reference is made to antibioitics, ie wide spectrum. (also note that testing for bacteria is not 100%, so that IBS may be a testing error...)

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 17:15, 3 August 2007 (UTC)

If you search Pubmed, I imagine there are papers that talk about this. EdJohnston 17:45, 3 August 2007 (UTC)

Bacterial Cause hidden by faulty testing.

Original research lead, that hopefully someone can input somewhere, somehow.

I just learned that giardia one of the most common parasites in North America requires 4-6 negative tests to prove you don't have.

Problem is that most doctors and some specialists don't know this, and after one or two tests for giardia, that are negative falsely assume that the patient does not giardia. Then there is no going back, and the patient never gets treated for giardia, or some other parasite that are often difficult to detect.

Problem is that there is so much money in keeping people sick in North America that why should they be treated for a possible cause, the possible outcome may be a cure.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 18:40, 10 August 2007 (UTC)

Thanks for your comment. If you can find a reference for this, it might possibly be added to the article. EdJohnston 19:07, 10 August 2007 (UTC)

http://www.google.com/search?hl=en&q=giardia+&btnG=Search I did a Google search and there is a lot of information to go through if anyone is interested. Just trying to help but not sure exactly what you are trying to say. --CrohnieGal^Talk 19:40, 10 August 2007 (UTC)

Forgot to say, I would do the research and read all of the articles but I will be moving in the next few weeks and have a lot to do to get ready. --CrohnieGal^Talk 19:42, 10 August 2007 (UTC)

Chaps, Caesar seems to believe that every illness is caused by bacteria. In IBS there is definitely a school of thought that includes bacterial overgrowth in the pathogensis, and there is some recent evidence that antibiotics may restore the balance. What I don't understand is his ludicrous claim that all IBS could be due to giardia (I challenge him on this) and that doctors don't know how to test for giardia. If we could have a bit less opinion and a bit more fact, that would be fantastic. JFW | T@lk 14:58, 17 August 2007 (UTC)

Proposed addition: Economic Costs of IBS

Hi All,

I'd like to solicit feedback on addition of a section on including the economic costs of IBS, as reported in medical journals. I'd probably put it after Epidemiology unless anyone thinkgs it should go higher up. Here's the proposed text: http://en.wikipedia.org/wiki/User:Gastro_guy/ibs_cost

Kind Regards,

Gastro guy 21:30, 13 August 2007 (UTC)

Looks good to me, but make it a == instead of the big section header you have there. -Wooty [Woot?] [Spam! Spam! Wonderful spam!] 23:35, 13 August 2007 (UTC)

Nice addition to the article. I think it's fine where you have suggested it be placed. Ibsgroup 00:59, 14 August 2007 (UTC)

Thanks! It's in. Gastro guy 17:31, 15 August 2007 (UTC)

Proposal to change epidemiology section

Hi All, I'd like to propose changing the epidemiology section. It doesn't have any references to studies. Here is my proposed replacement: http://en.wikipedia.org/wiki/User:Gastro_guy/ibd_prev In the spirit of the Medicine Portal's Style Guide, I'd like to propose renaming "Epidemiology" to "How many people have IBS?" to make it more accessible to the general population. Thanks, Gastro guy 17:32, 14 August 2007 (UTC)

Looks good to me. --CrohnieGal^Talk 21:13, 14 August 2007 (UTC)

Thanks! I made one or two final changes. I changed the section title. Instead of "How Many People Have IBS?" I think the section answers the possibly more interesting question of, "Who gets IBS?" (technically, that's what Epidemiology is). Gastro guy 17:34, 15 August 2007 (UTC)

The addition works well. Great addition! Ibsgroup 22:02, 16 August 2007 (UTC)

Misdiagnosis section

Regarding the revert on lactose, this entry occaisonally gets requests from people to add references to various conditions misdiagnosed as IBS (celiac, lactose intolerance, etc.) I've added a "Misdiagnosis" section which points to the List of causes of diarrhea, which is an innocuous list to which people can add their maladies which are misdiagnosed as IBS. Comments/Questions welcome Gastro guy 07:31, 21 August 2007 (UTC)

Lactose intolerance entry: I know that you mean well, but I removed because it conflicts with WP:MEDMOS#Audience and WP:MEDMOS#Careful_language, such as giving advice and diagnosing the patient. Diarrhea is a real problem, can be infectious, and should be diagnosed by a doctor. Write to me on my talk page User_talk:Gastro_guy for horror stories of self-diagnosis. The URL to an FDA page conflicts with WP:MEDRS. There new entry for lactose intolerance under Misdiagnosis has an appropriate secondary source. Hope that is OK. Gastro guy 03:58, 22 August 2007 (UTC)

IBS .lactose intolerance misdiagnosis reference deleted again - who has an agenda here?

The claim "No one knows what causes IBS..." is untrue speculation. It is semantically wrong. A syndrome is a group of similar symptoms which has been put under one umbrella by the medical profession. A syndrome may have a number of different causes. The key is finding the cause for each individual patient. To suggest (as one page editor has) that making a reference to Lactose Intolerance (which was backed up by an FDA reference, I may add) is wrong, is, I think, at best misguided. If I have mild cold symptoms I do not immediately assume that I have flu. I assume I have either a cold or hay fever until experience tells me I may have something more serious. Then I go to the doctor. If a doctor tells me I have IBS, then I should be able to see ALL of the possible causes, tests and treatments here on Wikipedia, so that I may gain a similar level of knowledge to that of the 'sneezing syndrome'. Claiming that a misdiagnosis reference on Lactose Intolerance is wrong (it has now been deleted by someone) is evidence that the deleter does not know as much as he claims he does. Lactose Intolerance is often misdiagnosed and shuffled off as IBS. The FDA makes it clear that Lactose Intolerance falls under the umbrells of IBS. So what on earth is going on here, when this reference (backed up) gets deleted?

The deletion _would_ have been just possible if the article was about diarhoea. It is not. It is about IBS. So the reference should be reinstated.

So, I strongly object to the lactose intolerance reference being taken out.

That is my 2c. (and thank you all for Wikipedia)

Gregpalmerx 18:44, 23 August 2007 (UTC)

I agree that the statement 'No one knows what causes IBS' is badly in need of a reference, and probably should be removed. That is different from saying that IBS is a poorly-understood disorder, which is part of the title of the FDA reference that was added by Gregpalmerx. I gather that this reference disappeared when Gastro guy moved the lactose intolerance item out of 'Symptoms' and into 'Misdiagnosis.' I agree with Gastro guy's overall layout, and I like it better when lactose intolerance is filed under Misdiagnosis, but I thought that Gregpalmerx's FDA reference might have value somewhere in the article. EdJohnston 19:24, 23 August 2007 (UTC)

Causes How about, The causes of IBS are not well established, so there is no specific laboratory test... I was working from this quote from Yawn (ref #2) Irritable bowel syndrome is a gastro-intestinal (GI) disorder of unknown etiology often described as a functional bowel problem. Here's a link to the article. Gastro guy 06:12, 25 August 2007 (UTC)

Lactose Intolerance': I think something could be written on Lactose Intolerance along Wikipedia guidelines, but the reverted entry suggested readers purchase medication which is available at supermarkets and inexpensive. Please see style guidelines for Medical Articles WP:MEDMOS#Audience. No diagnosing patients, no giving advice, don't write as if you were talking to a patient, etc. Think of it as an encyclopedia. Encyclopedia Britanica wouldn't tell you to go to a supermarket. Research the facts, present them to the reader. I didn't like the guidelines at first, but if we follow them, Wikipedia becomes credible and convincing. Gastro guy 06:12, 25 August 2007 (UTC)

Link to aboutibs.org not needed?

In spite of its name, the International Foundation for Functional Gastrointestinal Disorders does not appear to do much (or any) research. They provide a web site that has pictures of smiling people. All I could determine is that they raise money and they talk to Congress. Does anyone object if I remove this link? Our readers will not learn very much about IBS if they follow that link. EdJohnston 19:41, 24 August 2007 (UTC)

Good Article Review (10/2006) Followup

Hi All, I thought I'd create this one heading for Good Article followup items. The earlier review is at http://en.wikipedia.org/wiki/Talk:Irritable_bowel_syndrome#GA_Review Epidemiology Comments: I think Agne's concern on the Epidemiology section is addressed. Medical History: I'm willing to do this. (This is really interesting. In the 80's, the articles called it a psychosomatic disorder and talked about psychoanalysis. The most recent articles have found inflammatory markers in serum and tissue biopsies, which will be a great loss to the psychiatrists everywhere) Would anyone like to take on, "Article is too technical/Diagnosis section needs work"?: The Medicine Portal style guide suggests the "disease" articles like this should be geared toward patients. Maybe the article could reference the existing Wikipedia entry on the Rome Process. Maybe something shorter like, "There is no test for IBS. Physicians may diagnose IBS by excluding other causes, such as infections, celiac disease, cancer or food intolerances. Physicians also use the Rome Process which is a set of standardized rules..." Thanks, Gastro guy 18:54, 15 August 2007 (UTC)

(Sorry if I'm suggesting too many changes  :-) ) As part of the "History of IBS" request from Agne, I was thinking of describing how idea of the cause has changed over time. So this would become the "What Causes IBS?" section. Right now, "Pathophysiology" (oh, that is hard to spell) is a mixture of causes and co-morbidities. So I'd suggest splitting Pathophysiology into "What Causes IBS?" and "What Conditions Accompany IBS? (Co-morbidities)" I probably won't get to this for a week or so. I'm working on another page on the medical history of Emerging Gastrointestinal Pathogens like H. Pylori, Giardia, and Enterotoxic E Coli. Thanks! Gastro guy 19:09, 15 August 2007 (UTC)

You are welcome to borrow/steal/take any of the language I have used to briefly describe the Medical History on our Diagnostic Criteria page, http://www.ibsgroup.org/main/diagnosis.shtml It would be good to include Rome III, which I have not done yet. Ibsgroup 22:01, 16 August 2007 (UTC)

Thanks ibsgroup, I'll take a look. If anybody would like to proof a new article on Emerging Gastrointestinal Infections, here it is: http://en.wikipedia.org/wiki/User:Gastro_guy/emerg_work Am I meeting NPOV criteria? Minor changes->Edit away. Big change-> Email me (see my user page). The article includes a bug being investigated as the cause of Irritable bowel syndrome Thanks! Gastro guy 22:10, 16 August 2007 (UTC)

Diagnosis Section Change Here's a proposal for the Diagnosis Section. #1:Moved Rome Process details to wiki entry on Rome Process; #2:Created entry for Manning Criteria and referenced it from IBS page; #3:All diagnostic statements now have citations to medical articles; #4:Article is pushing WP:SIZE (3x too big) so this helps Gastro guy 17:43, 20 August 2007 (UTC)

NIH Spending Addition Here's a proposed change to the cost section. It lists NIH projects funded for 2005 and 2006 with IBS in the title. I checked at the WP:NOR talk page, and it apparently OK to create a subset of a published document if everyone can verify it. Gastro guy 19:55, 20 August 2007 (UTC)

(New entry - August 30) Causes of IBS - I think the GA feedback suggested a section on the history of what doctors have thought caused IBS. Here is my shot (I still have to fill in some references): User:Gastro_guy/ibs_notes. I was planning on replacing the Pathophysiology section with this, so I included co-morbidities. Questions/comments welcome. Thanks, Gastro guy 17:00, 30 August 2007 (UTC)

Inconsistency:

"A 3-year study found that patients diagnosed with IBS were 16.3 times more likely to develop IBD during the study period."

and further on... "IBS is not fatal nor is it linked to the development of other serious bowel diseases."

I don't know which is correct but wanted to point it out... joeygirl, sometime in September 2007 —Preceding unsigned comment added by 86.152.236.139 (talk) 19:36, 15 September 2007 (UTC)

Fixed. Gastro guy 04:18, 6 October 2007 (UTC)

My life long IBS is TOTALLY CURED since I omitted WHEAT from my DIET

Dear IBS sufferer,

I suffered from chronic IBS since forty years (I am now 51 years old). By accident, just to loose a few pounds of extra weight, with the recommendation of a friend, I stopped consuming wheat six months ago. Virtually after 24 hours of having wheat free diet, all my terrible life long symptoms of IBS disappeared! This is a fact. Ever since, I avoid all wheat in my diet and I no longer suffer from any IBS symptoms.

I have a new life and I never thought I will live to see this day. Try it for yourself. You have nothing to loose. —Preceding unsigned comment added by 59.96.0.70 (talk) 11:20, 25 September 2007 (UTC)

I got diagnosed as a young child with IBS. I got diagnosed with Crohn's disaese about 6 years ago. I don't eat wheat do to the CD and it hasn't changed a thing with my IBS. Glad it has helped you but please don't use cure. --CrohnieGal^Talk 13:24, 25 September 2007 (UTC)

The wheat allergy article mentions suspected IBS as one of the symptoms. Is it worth mentioning in this article? Pocopocopocopoco 01:20, 26 September 2007 (UTC)

Sorry but in my opinion is no but lets see what others think. My real concern is the use of the work 'cure'. --CrohnieGal^Talk 10:43, 26 September 2007 (UTC)

Agree with CrohnieGal, Pocopocopocopoco as you noted, wheat allergy may be a cause for "suspected IBS" rather than "IBS" itself. Given that almost by definition a confirmed underlying mechanism for IBS has not yet established, I think that on retrospection, 59.96.0.70 did not have IBS but rather IBS-like symptoms, with the actual problem finally being shown to be wheat intolerance (not mentioned if had any formal studies that might have shown if the allergic/immune disorder of Coeliac disease). Likewise, it is not uncommon to find people who have been diagnosed as having IBS who later determine that they have instead lactose intolerance, and a similar dietary change effects resolution of their problem. Similarly a person/doctor might consider IBS as a possible diagnosis of someone who later after investigation is shown to have had the early stages of Crohn's, but no one would suggest steroids or Mesalazine for IBS. In none of these cases are these cures of IBS, but rather cure of the symptoms of something determined (in hindsight) to an entirely different disorder.David Ruben ^Talk 12:55, 26 September 2007 (UTC)

Dear 59.96.0.70, I am glad to hear of your positive experience. To add what you request, we would need to see something in a medical journal that says, "IBS Patients Cured by Not Eating Wheat." (see WP:MEDMOS). If the American Journal of Gastroenterology or Gut Magazine publishes that, we can include it. The IBS entry notes celiac disease as a mis-diagnosis. Gastro guy 03:25, 27 September 2007 (UTC)

Fat

"Several of the most common dietary triggers are well-established by clinical studies at this point; research has shown that IBS patients are hypersensitive to fats and fructose."

I'm not too sure about this being "well-established." There are only a few studies regarding fat. All used liquid infusion and none break down fat by type. —Preceding unsigned comment added by 130.126.76.96 (talk) 23:05, 8 October 2007 (UTC)

Merge AGA Guidelines?

re: Suggestion to merge AGA Guidelines. This material was moved out of the article per the Good Article review, which suggested it got too detailed in technical description of how to diagnose IBS. The article was also too long (see WP:SIZE). Comments? Gastro guy (talk) 05:56, 8 December 2007 (UTC)

No followup? I'm removing the icon from the IBS page. Please use the discussion page if there is to be a discussion regarding this merge. Gastro guy (talk) 06:50, 22 December 2007 (UTC)

Prune the external links?

I'd like to remove everything in the current external links section. In my view, links to support groups aren't needed here, and the other items are surely of little interest compared to the serious and well-referenced article we already have. Please speak up if you see value in any of these links. None of these items serves as a reference currently (or it could be moved to the Reference section), and none of these groups is mentioned in the article. EdJohnston 00:27, 24 September 2007 (UTC)

I say prune it. From a quick glance though maybe the last two could be worked into the article. If I can help drop me a line on my talk page.--CrohnieGal^Talk 11:19, 24 September 2007 (UTC)

I'ld remove the Rome Criteria link, the article wikilinks 3 times to Rome process which is where it clearly is appropriate to link to teh organisation itself.

I agree "Women at higher risk for IBS" should, if everyone agrees, be worked into the article with link then as a footnote ref.

informedhealthonline.org is just to an encyclopaedic article, ie tertiary source, that does not give greater info that that found in this article (or should be found if at Featured status)

I would though tend to keep the major national charity groups for conditions, as these do tend have greater amount of info as well as peripheral information on campaigning, political pressure etc (which is generally inappropriate info for within wikipedia's own articles). So I would keep the GutTrust link, and add whatever is the US National Charity or link to US Institute (?NIH) of Gastroenterologist page on the topic (assuming it exists and adds meaningful extra info). David Ruben ^Talk 12:04, 24 September 2007 (UTC)

Thanks for the comments. The 'women at higher risk' idea could be followed up, but someone would need to find us one or more new articles we could add to the reference list. A gastroenterologist named Lin Chang has researched this, and a list of her papers is here. Do we have a volunteer who can access any of these papers and will select one? (or even a popular article by her if it can be found on Google).

With regard to support groups, if they are noteworthy I think a sentence or two might be included in the article, in which case a cite is justified. My concern with the support sites is they are sometimes fluffy and vague, and you need to go through endless screens to get any medical info at all. Often you don't find anything better than our own article. Perhaps we could adopt a rule that says 'Include up to one support group per English-speaking country?' EdJohnston 12:28, 24 September 2007 (UTC)

My $0.02 is keep links that are notable. Those that go to larger organizations who are funding or coordinating research (guttrust, IFFDC). Someone writing an article on IBS might need those for quotes from experts. Please drop link "Women at higher risk" That article doesn't meet Wiki standards for references. From what I could find, the question of higher prevalence in women is iffy. Some studies find men and women both get IBS at equal rates when surveyed (see pubmed ID's 17629228 and 15948818) but women may be more likely to go to the doctor. Probably for the same reason men can't ask directions :) I took a look at one of Chang's articles, and she was careful to note that "Women report symptoms more often" (see pubmed ID 11467651) In another of Chang's articles (Pubmed ID 15521853 ) she notes that there may be a skew toward women, but that this may be a study bias. Gastro guy 19:45, 24 September 2007 (UTC)

Removed link to Innate Health Foundation, which seems to be a registered nonprofit but sends people to "their partner" site, a naturopathic IBS Treatment Center at the exact same physical location, and which claims "There are several hundred potential causes of IBS, but they can be broken down into two major categories: Food Allergies and Intolerances; and Intestinal Microorganisms and Parasites." The IBS Treatment Center then offers tests for these, and the standard package price for these tests is $1148. Hvan (talk) 18:04, 26 February 2008 (UTC)

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