第９弾　MEと胃腸の問題

There are quite a few deviations known of the gastrointestinal system. In my opinion, gastrointestinal specialists don’t listen to their patients very well, as they probably could have been the first to identify the problem of ME and bring it to people’s attention.

The gastrointestinal complaints that ME patients have range from nausea to bad digestion, abdominal pains, constipation, diarrhoea, and a spastic colon直腸痙攣. It’s quite a list of symptoms, with more than 90% of all ME patients having gastrointestinal problems.

The stomach starts to contract poorly. We are familiar with the mechanism, it’s called gastroparesis. 88% of our patients suffer from a stomach paralysis or gastroparesis. Which of course leads to a situation where the whole digestion chain is disturbed. If the food stays in the stomach for too long, all other processes are no longer in sync. By then the pancreas will have had all its fluid secreted in the intestine, where there is still no food because the stomach is contracting too slowly. Therefore patients will often experience an immediate feeling of being full and not being able to eat anymore, because the stomach is filled directly and is not emptied.

The number of people with ME that take so called H2 blockersH2 is higher than 90% I would say. H2 blockers inhibit gastric juice secretion, not only due to a disturbed gastric acid secretion, but also due to the fact that there is a backflow of stomach contents into the oesophagus. This causes the lower portion of the oesophagus to become irritated, which in turn is a source of chest pain, of waking up at night with pains, which also leads to digestion problems and not being able to eat properly.

There are intestinal absorption problems at the level of the intestine because many ME patients develop food intolerances – intolerances that they didn’t have in the past. This again has to do with the immune system. It would be going too far to explain this in detail here, but we do notice the occurrence of food intolerances.

We know that food tolerance builds up between the ages of 1 day and 15 months. During this period, we gradually learn to tolerate and digest all types of food. In fact, patients lose a part of the tolerance that they had built up in the past. This has to do with changes in the underlying immune system.

Diarrhoea and constipation are sometimes major problems. Changes occur in the peristalsis. We think this also has to do with a number of toxic substances. Such as NO, a gas that is known to be more often released in ME patients. NO paralyzes smooth muscle tissue, and the entire gastrointestinal system consists of smooth muscle tissue. Also what we call the autonomic nervous system - the parasympathetic and the sympathetic nervous system - in ME patients is disrupted. We see that a clearance of substances takes place in the stomach, sometimes resulting in explosive diarrhoea alternated with constipation.

Then we also have the intestinal flora. With this condition, the pH of the intestine is altered considerably. We notice an overgrowth of certain categories of intestinal bacteria and that other intestinal bacteria do not quite die out but do decrease gradually in quantity. As a result, a dysbiosis occurs, an imbalance in the composition of the intestinal flora. This has implications for the release of toxins. Very recently we found that one specific type of bacteria – Lactonifactor – has multiplied tremendously in ME patients compared to control groups. We discovered this in both Belgian and Norwegian patients.

This type of bacteria is of the family, with which we are familiar and which is responsible for the production of a certain toxin, which again changes the metabolism in another way. But we also see for example that E-coli, a beneficial type of intestinal bacteria, is often present to a much lesser degree. E-coli is responsible for instance for the production of amino acids – the precursors for serotonin and dopamine in the brain – the happy hormones. Dopamine is considered to be a happy hormone, while serotonin is associated with depression. So it is highly likely that a number of co-morbidities, such as depression, are partly caused by this dysbiosis, this abnormal composition of the intestinal bacteria.

This summary is by no means complete. Very many digestive problems exist and we generally focus a lot of attention on these, because the intake of food is essential. A small percentage of patients must even be fed in a different way, for example through tube feeding, because enormous problems regarding food tolerance and the regular movement of the gastrointestinal system have arisen.