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Opioids and GI Problems: What's the Connection?

Opioid addiction is on the rise in this country. The U.S. Department of Health and Human Services reports more than 42,000 overdose deaths in 2016 and that number continues to grow each year. The consequences of this epidemic go beyond the risk of overdose, though. the chronic use of drugs like heroin, Oxycontin or Roxicodone has a staggering effect on the human body, as well, including the gastrointestinal tract. Consider some ways using opioids can impact your GI tract.

Why is Opioid Use on the Rise?

The National Institute of Drug Abuse states the opioid crisis actually began in the 1990s. Pharmaceutical companies marketed opioid drugs to the medical community claiming they were not addictive. With that reassurance, physicians began prescribing these drugs to their patients to relieve pain. The increase of prescription opioid drugs circulating among the population eventually led to rampant misuse and addiction.

Anyone who takes an opioid drug has the potential to become addicted. Opioids stimulate the pleasure center of the brain in such a way that users feel they can’t live without that feeling. Their tolerance level builds up, so they need more of the drug to get high and fulfilling that craving takes over their lives.

The Gastrointestinal Side Effect of Opioid Use

There are a number of complications associated with the short and long-term use of opioids. For example, the drug may lower your blood pressure, especially when combined with over-the-counter medications or alcohol. It’s the gastrointestinal tract that is affected the most, though. Opioids work by acting on opioid receptors throughout the body and there are a great number of these in the GI tract.

It is estimated that around 25 percent of people get physically sick after taking an opioid but nausea and vomiting tend to pass quickly. It’s the long-term consequences of addiction that are the most alarming including opioid bowel dysfunction.

What is Opioid Bowel Dysfunction?

Opioid bowel dysfunction is something that can happen to anyone taking opioids whether it’s to feed an addiction or for therapeutic use. The primary symptom of Opioid Bowel Dysfunction is constipation, a problem that affects around 40 percent of opioid users. There are a number of factors associated with constipation but often it is the result of poor muscle control in the intestines. Ineffective muscle contractions lead to waste material becoming trapped, making bowel movements difficult.

With opioid bowel dysfunction you may also experience:

  • Abdominal cramping
  • Bloating
  • Gastroesophageal reflux

Chronic gastroesophageal reflux can cause burns to the esophagus and lead to permanent damage.

Managing GI Tract Problems Associated With Opioid Use

Opioid-induced constipation is a potentially debilitating side effect of these drugs. What can you do to reduce the risk if you do need narcotic pain relief? The first step is to talk to your doctor. It is possible that there is a way to treat the GI side effects and reduce the impact of the drug.

You should also take steps to prevent constipation such as:

  • Drinking hot water or herbal tea in the morning
  • Drinking more water throughout the day
  • Eating more fiber or taking a fiber supplement
  • Talk to your doctor about taking a laxative or stool softener

Before taking an opioid pain reliever, tell your doctor if there is a history of drug or alcohol abuse in your family, if you smoke or have a drinking problem and if you have any mental health issues like depression.

The National Institute on Drug Abuse estimates that around 80 percent of people who use heroin initially became addicted by taking prescription painkillers. Talk to your doctor about other ways to control chronic pain and avoid taking opioids when possible.

 

The Difference between Allergies and Intolerances

 

Food allergies and food intolerances may seem similar at first glance, but are really quite different. It is important to know the difference between the two, especially if you prepare food for others.

Physical reactions to certain foods are common. In most cases, though, these reactions are the result of food intolerance rather than food allergy.

Anyone who suffers a reaction after eating a certain food should see a medical professional, who can perform an evaluation and tests to determine whether the patient has a food allergy or a food intolerance. Getting tested is important because those with food allergies are at risk for anaphylaxis, which is a life threatening allergic reaction. Even people who have had mild allergic reactions to food in the past are at increased risk for anaphylaxis.

Food Allergy vs. Food Intolerance

Food intolerance often causes the same signs and symptoms as food allergy, so it is easy to confuse the two reactions.

A food allergy causes a reaction of the immune system; this reaction affects several organs and body systems to cause a wide range of symptoms. Reactions associated with food allergies can affect the person’s skin, gastrointestinal tract and respiratory tract. In the most serious cases, food allergy reactions can even affect the cardiovascular system. An allergic reaction to food can be severe or even life threatening.

Symptoms of a mild to moderate allergic reaction to food include hives, which are itchy, swollen and reddish areas on the skin. Eczema may occur as a persistent dry, itchy rash. Skin redness, especially around the eyes or mouth, may occur. Itchiness, nausea or vomiting, diarrhea, stomach pain, cough, and a runny nose may develop.

Symptoms of anaphylaxis include swelling of the throat, lips, or tongue that blocks breathing, trouble swallowing, wheezing or shortness of breath, turning blue, and feeling faint, weak, confused, or passing out.

Food intolerance, by contrast, usually causes mild to moderate symptoms that are usually limited to the digestive tract. Symptoms of food intolerance usually take longer to develop than symptoms of food allergy. These symptoms include nausea, vomiting, gas, bloating, stomach pain or cramps, heartburn or diarrhea.

Someone with intolerance to a particular food may be able to eat small amounts of that food without experiencing symptoms. The individual may also be able to prevent a gastrointestinal reaction. A person with lactose intolerance may be able to take a lactase enzyme pill to aid in the digestion of milk, for example. Someone with a food allergy can never consume that food.

Causes of Food Intolerance

A variety of factors can cause food intolerance. Causes of food intolerance include:

  • Lack of lactase, an intestinal enzyme normally that breaks down the lactose in milk and dairy products, which causes lactose intolerance
  • Irritable bowel syndrome, which causes cramping, constipation and diarrhea
  • Sensitivity to food additives, such as the sulfites used to preserve canned goods, dried fruit and wine, can trigger asthma attacks in people sensitive to sulfites
  • Recurring stress or other psychological factors can make a person feel nauseated at the mere thought of food

Celiac disease presents some features of a true food allergy because it involves the immune system. Because the symptoms are localized to the gastrointestinal tract, and because the condition does not cause anaphylaxis, celiac disease is usually categorized as food intolerance. Celiac is a chronic condition in which eating gluten, a protein found in wheat and other grains, triggers digestive symptoms.

People diagnosed with food allergies may need to carry injectable epinephrine to self-administer in case of anaphylaxis.

Medical professionals often recommend steps to aid digestion of certain foods or to treat any underlying conditions causing the localized reaction of food intolerance.

Recognizing anaphylaxis and knowing what to do if one occurs can save lives. So can preparing meals with food allergies and food intolerance in mind. Anyone cooking for people who may have food allergies or food intolerance should look into purchasing a cookbook that provides recipes for those with food allergy or food intolerance.

Options for Treating Gastrointestinal Diseases, Especially SIBO

doctor holding intestine diagram

Abdominal pain is one of the most common complaints seen in emergency rooms and doctor's offices, according to a 2012 report published in Gastroenterology. The reason for GI tract disturbances vary but more and more practitioners are testing for small intestine bacterial overgrowth (SIBO) as the possible cause.

The normal flora of the small intestine includes both good and bad bacteria. For people with SIBO, one form of microorganism has overgrown, disrupting this balance. The result is symptoms of bloating and stomach pain. What causes SIBO and what are the treatment options?

What is SIBO?

The human digestive sustem is supposed to be a balance of pathogenic (bad) and beneficial (good) bacteria. They keep each other in check to maintain this delicate ecosystem. In some people the system fails, though, and one type of bacteria takes over and disrupts the normal functioning of the digestive tract.

Some symptoms of SIBO include:

  • Abdominal bloating and distention
  • Gas
  • Diarrhea
  • Pain
  • Malnutrition
  • Unexplained weight loss

It's a condition that is often associated with irritable bowel syndrome (IBS), so the two have similar symptoms.

The Dietary Approach to Treating SIBO and Other Gastrointestinal Disorders

Proper diet is an essential first step in the management and treatment of disorders like SIBO. The Physician’s Elemental Diet, for example, offers a nutritional balance to ensure those with gastrointestinal problems get essential vitamins, electrolytes and minerals. The diet consists of a powdered formula that is gluten, soy and dairy free and hypoallergenic. This plan should be used under medical supervision and is effective both as the sole food source or in combination with a strategic half-diet plan.

The nutrients in the elemental diet come predigested, making them easier to process. For best results, the elemental diet should not include any additional food beyond the powdered formula for at least two to three weeks. It is a strategy that has proven to improve the symptoms of SIBO.

Once food is reintroduced into the diet, the timing of meals is essential. Fasting can trigger contractions in the small intestine that help clean it of excess bacteria. For this reason, treatment recommendations for gastrointestinal diseases often include four to five hour gaps between eating and, at least, 12 hours at night.

What About Medical Intervention for GI Diseases?

For SIBO, the most common treatment is antibiotics. The problem with this approach is that SIBO is typically chronic. As soon as you stop taking the antibiotics, the problem recurs.

Some people respond well to the long-term approach offered with herbal antimicrobials and other herbal supplements that support a healthy intestinal tract. Supplements that contain Oregon grape, for example, are used clinically to control bacteria growth in the small intestine. For other GI diseases like IBS, adding fiber supplements and pain medication help manage the symptoms.

SIBO is just one of a number of gastrointestinal conditions that can have an impact on your life. Finding the right balance of therapeutic treatment, diet and supplements may be the key to feeling better.

 


 

What is Small Intestine Bacterial Overgrowth (SIBO)?

Bacteria

Small intestine bacterial overgrowth (SIBO) is a disorder characterized by an excessive growth of bacteria in the small intestine. The large intestine normally has high levels of bacteria, but the small intestine should be virtually free of bacteria by comparison. SIBO causes various gastrointestinal symptoms that are also shared by many other disorders, making a positive diagnosis challenging. 

Symptoms

The symptoms of bacterial overgrowth include the following:

  • Abdominal distension
  • Abdominal pain
  • Bloating
  • Constipation
  • Diarrhea
  • Fatigue
  • Flatulence
  • Nausea
  • Weakness

Bacteria in the small intestines metabolize nutrients, which prevents those nutrients from being absorbed through the intestinal walls. The byproducts of this metabolism can inflame the small intestines, causing many of SIBO’s symptoms. The malabsorption of nutrients can also cause weight loss and malnutrition, which can have particularly severe consequences in developing children.

Long-term Effects

The long-term effects of SIBO include anemia, which can develop through a variety of mechanisms. The production of red blood cells is particularly sensitive to nutritional malabsorption since iron is primarily absorbed by the first parts of the small intestine, primarily the duodenum and jejunum. The malabsorption of iron can cause red blood cells to be smaller than normal, a condition known medically as microcytic anemia.

SIBO can also result in the malabsorption of vitamin B-12, which normally occurs in the last part of the small intestine, or ileum. This type of malnutrition can cause many conditions, including large red blood cells, or megaloblastic anemia. Older adults with chronic SIBO also have a lower body mass index, a higher rate of diarrhea and a lower level of serum albumin.

Diagnosis

Bacterial metabolism of carbohydrates in the small intestine produces a number of byproducts, including hydrogen and methane. These gases can be detected by various methods, which are often used as presumptive tests for SIBO. Testing the level of hydrogen and methane in the breath generally requires the patient to fast for at least 12 hours before drinking a substrate containing a sugar such as glucose or lactulose. The level of these gases in the patient’s expired breath can then be measured over a period of several hours. This type of test compares favorably with the measurement of aspirates from the jejunum, which is the gold standard for diagnosing SIBO.

The small intestine normally has less than 104 bacteria per milliliter (ml) of aspirate, so a level above 105 bacteria/mm is typically considered to be SIBO. However, some experts set the threshold for SIBO at 103 bacteria/mm if the bacteria are primarily colonic types, which are more likely to cause pathological conditions in the small intestine.

SIBO has a significant overlap in findings with other gastrointestinal conditions such as post-infectious irritable bowel syndrome and tropical sprue. Furthermore, an acute gastrointestinal infection can occasionally trigger SIBO.

Treatment

A course of antibiotics is the most common treatment for SIBO, although it isn't always a first-line treatment. Some experts recommend probiotics, prokinetics, specialty diets and/or herbal antimicrobials as the first-line treatment, while reserving antibiotics as the second-line treatment for severe cases of SIBO. Rifaximin provides the best evidence for use for diarrhea-predominant SIBO, although the following antibiotics have been referenced for use to treat SIBO:

  • amoxicillin-clavulanate
  • cephalexin
  • fluoroquinolones
  • metronidazole
  • neomycin
  • nitazoxanide
  • tetracycline
  • trimethoprim-sulfamethoxazole

A one-week course of antibiotics is usually sufficient to treat SIBO. However, a recurrence may require a cyclical course of treatment with to prevent the bacteria from developing a tolerance for the antibiotic. A cyclical course may consist of using the same antibiotic for one week, then discontinuing treatment for three weeks and repeating this cycle. Another type of cyclical therapy is to change the antibiotic at regular intervals. Prokinetic drugs are another treatment option for SIBO, although the current research on this application is still developing.

The underlying condition resulting in the patient’s predisposition to SIBO should also be treated. For example, if the SIBO was caused by chronic pancreatitis, the patient should receive pancreatic enzyme supplements.

Summary

QuinTron Instrument Company, Inc. is an industry leading manufacturer of non-invasive breath analyzers and breath test kits. We provide patented breath tests to help physicians narrow down the root cause of their patients’ gastrointestinal issues. We also have developed specialized testing products for other applications such as cancer research, veterinary sciences, naturopathic medicine and pharmaceutical research. Call us today to find out how we can help you.