Gastrointestinal Disease

IAH AC Gastrointestinal Disease

IAH 2007

Body surfaces
Skin =
2 square metres Respiratory tract = 80-100 square metres Urogenital tract = 60-80 square metres GIT = 300-600 square metres

IAH 2007

The gastrointestinal tract is one of the most specialized organs in the body. It is the largest surface of the body in contact with the outside world, and through evolution has become very specialized in order to assure optimal absorbtion of nutrients, yet to keep invaders and toxins on the outside. It has a surface of 300-600 square metres, and through the luminal surface will be in direct contact with toxins, gases and of course the nutrients that is needed.

The intestinal mucosa

Has the paradoxical function of: Barrier Filter The barrier function of the mucosa is demonstrated in the
following two slides: Graphic Pictorial

IAH 2007

For this purpose, the gastrointestinal mucosa has a paradoxical function, that of a very specialized filter, but at the same time also a very selective barrier. As a filter it needs to allow the passage of nutrients, but at the same time act as a barrier to toxins and other undesired substances. It is thus clear that this will need a very specialized arrangement. This will be viewed on the next slides

5 blood 4
receptor for e.g. corticotrophic hormone

liver

tight junction immune system

3
bacteria food particles

1.

mucous and unstirred water layer

gut lumen the intestinal barriers

IAH 2007 4

The intestinal tract and the liver comprise of 5 barriers which will keep undesired particles out of the body. These are: 1. The mucous and water layer covering the mucosa on the luminal side 2. The symbiotic bacteria, which through their numbers form a passive barrier on the luminal side, so that toxins do not come into contact with the gut lining, but also will use certain toxins in their metabolism, and therefore will render them harmless before they even come into contact with the mucosa. 3. The tight junction. This is the most important barrier, and is not an anatomical barrier, but rather a channel, which closed integrity is kept up by active action of the adjacent mucocytes. This means that the cells need energy and fuel to be able to keep up this physiological function. Should the energy in the epithelial cell fall, or there are not enough nutrients, this barrier will be impaired. Infections, stress and toxins, like alcohol can all affect this important function. 4. The gut immune system or GALT form the 4th barrier (see later) 5. The liver is the last barrier, as all the blood from the gut drains to the liver via the portal vein, and toxins can be finally metabolised and made harmless here, or made water soluble for excretion.

The mucosal barrier

From the gastrointestinal
brochure Heel Inc., USA, October 2004: Text: Alta Smit Graphics: Andrew Mingione

IAH 2007

The Gut associated lymphoid tissue (GALT) is the largest aggregation of immune competent cells in the body. The loosely aggregated lymphoid tissue in the lamnia propria,and the so called Peyers patches, as well as the tonsillar rings of Waldeyer forms the GALT. All antigens which get into the post mucosal location will be processed by the GALT. A deeper barrier is formed by the mesenteric lymph nodes, which are the biggest in the body. The immune reaction will differ due to the frequency of contact and the concentration of the antigen. Small concentrations of antigens which has a short exposure will induce tolerance, whereas high concentrations of antigens with longer exposure will tend to induce inflammation. This is important when we look at the effect of low concentration antigens later in the lecture. The gut lining is further a small PNEI (Psycho neuro- endocrine-immune) system in its own right. For instance, the mucocytes have got receptors for Cortico Releasing Hormone (CRH) and will respond to stress with increased permeability. The gut brain axis, has been well researched, and plays a major role in the gut diseases associated with a psychosomatic component, like Irritable Bowel Syndrome and Inflammatory Bowel Disease (see later)

 Antigen presenting cells Intraepithelial cells Dendritic cells Neutrophils Macrophages

recognition

Antigen is presented mostly via the MCH II. In some patients this is aberrant and leads to IBD

activation

T cell response, non-specific local immune response, with mast cell as transducer

response

IAH 2007

Determination of which immune reaction will be induced, will depend on the antigen presenting cell taking up the antigen. In the gut a special class of APCs (antigen presenting cells) namely certain dendritic cells will respond differently to different antigens. This will start the differentiation into a tolerant reaction or an inflammatory reaction. Dendritic cells will respond to the antigens presented by a special class of cells, the M cells in the epithelium, or directly to antigens getting through the tight junction. Some patients will be genetically predisposed to generate an inflammatory response, rather than the normal tolerant response in the gut. This will predispose then to diseases like Crohns disease. A large body of research is now available in these individual differences in the immune response in the gut.

The function of the mucosal lining as an immune organ Permeability MHC secretion Antigen presentation Secretory component Adhesion molecule Presentation Immunocyte chemo Attractants Antimicrobial activity

IAH 2007

The epithelium itself plays a very important role in immunity. Through the integrity of the Tight Junction, the size of antigens is controlled, so that under normal physiological conditions, only small amounts of antigen is processed by the GALT. This leads to natural tolerance. The gut further secretes Major Histocompatibilty proteins, especially Type II which play a role in antigen presentation. The M cells interspersed between the epithelial cells are specialized Antigen Presenting cells. IgA is the major antibody active in the gut, but needs a secretory component to function. This is provided by the mucosal cells. The mucosa will also secrete chemokines which under special conditions will attract immune cells to the gut by virtue of chemotaxis. Lastly the gut lining will secrete several antimicrobial peptides, which plays a role in host defense.

The antigenic response in the gut

Is always geared towards tolerance and anti-inflammation Mediated by the Th2, Th3 helper cells and the T suppressor
cells The activation of this is dependent on the Concentration of the antigen Type of antigen presenting cell Specific antigen presenting cells will take up homeopathic dilutions in D1-14 dilution, which will induce TH3 cells and secrete TGF-beta

IAH 2007

By nature, and for obvious reasons the immune reaction in the gut is geared towards a TH2 type response, thus a tolerant response. Furthermore, the gut has the most of the inducible type T reg cells, namely TH3 cells. These cells are stimulated in the gut lining when the concentration and the frequency of the antigen exposure is very short and very low concentration. This has been seen by Heine and his co workers to be the case with low diluted plant material, such as Traumeel and certain suis organ extracts. Schmolz, Manfred; Heine, Hartmut Homopathische Substanzen aus der Antihomotoxischen Medizin modulieren die Synthese von TGF-1 in menschlichen Vollblutkulturen. Biologische Medizin 2001; nr 2 61-65 This natural reaction towards tolerance ensures that we do not make an inflammatory response to the food we eat, which contains substances which we do not necessarily use. However when the integrity of the gut lining is disturbed, the amount of antigen that could enter into the body is so high that it can cause an inflammatory response. Some patients will be genetically predisposed to generate an inflammatory response, rather than the normal tolerant response in the gut. This will predispose then to diseases like Crohns disease. A large body of research is now available regarding these individual differences in the immune response in the gut, and forms the part in the quest to find the aetiology of inflammatory bowel disease as well as to design new treatment strategies.

Breast is best!!

Photos: WHO Ethiopia

IAH 2007

The gut lining in an infant is wide open to allow for the absorption of vital factors in breast milk, such as transfer factors amongst others. It closes at about 20 months when intestinal permeability is fully established under physiological conditions. Till then, breast milk will also gear the gut immune response towards tolerance, so that breast fed babies are known to have fewer allergies in later life. If a baby is fed foreign protein, like the casein in cows milk, for instance, too early allergy will ensue.

Vaccination

IAH 2007

10

Due to the fact that the immune system is so well balanced in the gut, orally given immunizations such as polio, is much more tolerable, as they are processed with the T reg cells on stand by if the response will overshoot. Polio is such a vaccine.

10

Environment

IAH 2007

11

The gut is at onslaught of the environment in the form of drugs like chemotherapies, lifestyle toxins such as alcohol and what is in food, as well as the scourge of our modern times, the stress factor. From the above it should be clear that psychological stress has a devastated effect on the gut lining and will contribute significantly to systemic disease. Heavy metals, from amalgams and food also damage the gut lining, and can cause dysbiosis. Chemo and radiation have a special devastating effect on the gut lining, as it will in fact affect the fast turnover tissue, of which the GIT mucosa is one together with the gonadal cells and the hair follicle. In all patients who has received chemotherapy, the gut needs to be seen to be damaged.

11

Mucosal distress (1)

Term refers to the breakdown in the integrity of the mucosal
surface so that one or more of the above mentioned functions cannot be carried out It seems that when one mucosa is affected in one organ, all the mucosae are affected (Rosales 2004) The result is not only local disease, but also systemic disease

IAH 2007

12

From modern investigation, it is becoming clearer that patients having disease in one mucosa, is probably affected in all mucosae. This comprise the so called mucosal stress syndrome, and was examined by Rosales in 2004, where he could show for instance that patients presenting with a disease process in one mucosa, such as the respiratory mucosa is also likely to suffer from GIT and vaginal symptoms. Rosales-Estrada M: Mucosal inflammation syndrome in allergic disease. Journal of Biomedical Therapy Winter 2007 : 3-5 Due to the fact that the gut mucosa is so large, and relatively easily affected orally, this can form the point of entry to restore mucosal integrity in other locations as well. In many cases of immune modulation, the mucosal membrane is thus the preferable point of entry into the body.

12

Mucosal distress (2)

Examples, where mucosal breakdown is implicated in disease: Inflammatory bowel disease Arthritis (sero-negative and rheumatoid arthritis) Septicemia following extensive burns Allergy Skin disease e.g. psoriasis

IAH 2007

13

Many systemic diseases are now linked to mucosal distress, such as IBD, where it is for instance known that patients suffering from Crohns disease will have a higher incidence of leaky gut just before a relapse, and that a high percentage of their siblings will have a leaky gut,even without having Crohns disease. Rheumatoid arthritis is closely linked with bacterial endotoxins in the gut, to the point that tetracycline is a common treatment for RA. If the gut is leaky, more of these endotoxins can enter the body and cause disease. The mucosa also leans itself to manipulation of the immune system in these type of diseases. A large number of researches are currently looking at the effect of oral tolerance on disease. For e.g., in Crohns disease: Margalit M, Israeli E et al. A double-blind clinical trial for treatment of Crohn's disease by oral administration of Alequel, a mixture of autologous colon-extracted proteins: a patient-tailored approach. Am J Gastroenterol. 2006 Mar;101(3):

13

 IAH 2007

14

Increased permeability( so called leaky gut ) plays a tremendous role in the development of disease. Like the Austrian Physician FX Mayr already said so dramatically, The death lurks in the gut. Above are the factors which will increase the physiological opening in the diameter of the tight junction. The mechanism will vary in the different cases. NSAIDs can both damage the mucosa, but also interfere with the energy production of the cell, so that the mucocyte cannot ensure the integrity of the tight junction. Especially infestations, like worms and parasites can cause a leaky gut Even after a normal viral infection, like a rota virus, a child will have a leaky gut for a few weeks. Burns patients and multi trauma patients often die of overwhelming infection, not from the wounds, but from the endotoxins absorbed through the gut lining which opens under this stressful conditions. The role of the stress hormones have already been mentioned. Psychological stress affects the gut brain axis, which in turn will cause an increase in the permeability of the gut, and predispose to disease.

14

Vicious cycles of changed permeability

Immune activation or suppression Food intolerance Hepatic overload Bacterial dysbiosis Low grade pancreatitis (partially digested foods)

IAH 2007

15

Increased permeability will led to a couple of vicious cycles: The first is an increase in food intolerance and also changes in the immunity. The immunity goes down when the symbiotic bacteria are not stimulating the immune system enough, whereas if the food and toxic particles get into the gut lining in too high quantities,it will set off an inflammatory process. (see the next slides) The liver, being the last barrier, will bear the brunt of chemicals and environmental toxins leaking through the gut lining, and all patients with a leaky gut should be considered to have liver overload. The symbiotic bacteria and the gut lining have a very special relationship. The gut lining, if healthy, will maintain a milieu for the bacteria, and conversely, the bacteria will in their metabolism secrete substances such as propionic acid, which will act as a fuel source for the gut cells. New evidence even suggest this symbiotic relationship to exist to the point where there is cell to cell communication between the bacteria and the gut lining. If the permeability is disturbed this is lost, and dysbiosis will ensue. Lastly we see a low grade malapsorbtion, as the exocrine pancreas is affected.

15

I. Allergy and inflammation

Locally in gut Neutrophils(frustrated neutrophil) Lymphocytes Chemical mediators
Mast cells, histamine Bradykinin Serotonin

IAH 2007

16

Inflammation in the gut locally can cause a lot of tissue damage. This is mediated by the neutrophils part from the process outlined in the previous slide. If the food particles are too big for the neutrophil to engulf it totally the peroxides etc. which the neutrophil secreted to inactivate the toxins, will leak out of the cell, causing damage to the adjacent tissue. This is the concept of the so called frustrated neutrophil Furthermore, a paracrine reaction will also take place and serotonin and bradykinin will be secreted. Last but not least is the role of the mast cell. The mast cell is a type of 6th sense in the gut, and respond very quickly to set off a whole chain of events. TH 1 cells are also activated in the view of large amount of antigens, and TNF alpha, the major cytokine secreted by TH1 cells is responsible for a lot of the phenomena we see in diseases like Crohns. This will set of another vicious cycle of inflammation and tissue damage. In diseases such as Crohns , we see for instance a deficiency in TGF beta, so that repair of the gut is also impaired. Immunomodulation as a pillar is a very important part of the treatment of patients with increased intestinal permeability.

16

Lactose intolerance, not immune-regulated

Often from birth (familial)
- Germany 10% - Asia and Africa 90% Therapy by substitution of lactase (Lactizyme, Digestizyme) Diagnosis through the Hydrogen Breath Test Secondary after parasitic, viral, bacterial infections, reversible after cure

IAH 2007

17

Several conditions can cause problems in the gut lining, such as lactose intolerance as well as celiac disease. Both of these have a genetic component, but gets worse when the permeability goes up. Lactose intolerance is due to a inborn absence,or an acquired absence of the enzyme lactase, which will digest the milk sugar in diary products. A high incidence exist in Africa and Asia where it is mostly genetic, but it can also be caused by for instance temporary damage to the gut mucosa, such as can occur after infection. The test to diagnose this comprise blowing exhaled air into a machine, which will measure hydrogen. If too high, lactose intolerance is diagnosed. It can be treated by replacing the missing enzyme, or in the case of acquired lactose intolerance, by treating the underlying cause as well. The role of intestinal permeability in celiac disease is depicted in the next slide.

17

 IAH 2007

18

The above slide depict the importance of increased intestinal permeability in the development of celiac disease. The gliadin from gluten together with the tight junction proteins are taken up by the dendritic cells and will stimulate both a TH1 and TH2 response, both which has damaging effects. Apart from the local inflammation which is caused by this, we also see the systemic manifestations which can be the result of such a leaking of gliadin through the open gut lining. This forms the basis of many auto immune diseases which are increasingly seen to be associated with increased intestinal permeability.

18

Food allergies
Positive skin test Positive test meal

Peanut

26

12

Chicken egg

19

10

Cows milk

17

Soy

10

IAH 2007

19

There is a lot of confusion between food intolerance and food allergies. Food allergy always means a immune reaction involving IGE, whereas food intolerance are often mediated by neutrophils and can give a rise in IgG or even IgM. True food allergy can become a medical emergency. Above are examples of food allergy and their incidences in the German population

19

Cross allergies
Birch pollen Apple, peach, apricot, celery (raw), Hazelnut, cherry, almonds, kiwi fruit, fennel Wormwood pollen Celery, fennel, dill, aniseed, carrot, caraway, Pepper, paprika, mango, melon, cucumber, chilli Grass pollen Tomato, pulses, grains Natural latex Bananas, avocado, grains

IAH 2007

20

It is also important to note that a number of cross allergies exist, where a patient may have an allergy to pollen, and then have a cross allergy to food. The reverse is also true. For instance, a patient who develop a allergy to bananas may suddenly react to latex gloves.

20

II. Liver overload

All the blood from the gut drains through the liver, this will cause
an overload of toxic material if the gut is too permeable

IAH 2007

21

Liver overload is the second vicious cycle of the leaky gut, as all the blood of the gut drains through this organ via the portal vein. It is important to keep in mind that all patients with increased intestinal permeability will have a liver overload, and by inference a systemic toxicity. Detoxification and drainage as a pillar is thus of high importance when treating patients with a leaky gut.

21

III. Bacterial dysbiosis

Bios = Life, sym = with Dys symbiosis: outcome not good Yeasts: problem for systemic immunity Parasites more often seen e.g. Blastocystis hominis E. coli and other pathogens can be the main culprit

IAH 2007

22

We live in harmony with some bacteria in the gut and have developed a good relationship with them. There is even cross talk between the proteins of these bacteria and the cells of the body. When this balance is disturbed, we see a condition of dysbiosis, which can be quite dangerous. Friendly bacteria belong to the Lactobaccilus group, etc. Dysbiosis can be caused by protozoan parasites (Entamoeba histolytica, Entamoeba coli, other Entamoeba, Dientamoeba fragilis, Endolimax nana, Giardia lamblia, Blastocystis hominis, Chilomastix mesnili, and others); yeast (Candida albicans, other Candida species, Torulopsis glabrata, and others); or bacteria (Salmonella, Shigella, Campylobacter jejuni, Yersinia enterocolitica, Klebsiella pneumoniae, Citrobacter freundii, Citrobacter diversus, Proteus mirabilis, Pseudomonas aeruginosa, some strains of Escherichia coli, Staphylococcus aureus, some strains of Bacteriodes, Clostridium difficile, and others).

22

Gut milieu luminal contents and pH

bacteria

immunity: strains important

e.g. Acidophilus DDS, Rhamnosus
IAH 2007

barriers see before

23

Symbiotic bacteria is vital for our health. The important role has been seen in animal experimentation, when the gut is sterilized, these animals will die of infection. The relative non pathogenic antigens of these friendly bacteria will stimulate the immune system of the GALT and keep it ready for infection. Symbiotic bacteria have a host of other actions, such as metabolizing certain toxins in the gut, such as heavy metals. Some of the metabolites of symbiotic bacteria, such as propionic acid serves as fuel for the enterocytes. The bacteria contribute to the good milieu in the lumen of the gut and keep the pH in the optimal range. They also give competition to invaders by competing for resources. Lastly, they for part of the passive barrier, so that toxins will not even come into contact with the gut lining. It is clear from the above that the inoculated bacteria should be live in order to recolonize the gut. For immune stimulation the proteins in the cells walls are sufficient, but for tall the other functions, live bacteria is needed. A cold chain for the transport of the bacteria is thus of utmost importance. This can be difficult, in a practical way, but is of such importance that it should be the ideal situation

23

Some symbiotic bacteria

Ingredient Function

Lactobacilli: main species: lactobacillus acidophilus Bifidobacteria: main species: bifidobacterium longum

Most important in aerobic milieu; assist apart from other functions formation of dextro-rotatory lactic acid The most common in the anaerobic milieu, and apart from other functions degrade harmful substances

Dextro-rotatory lactic acids

Energy source for the mucosal cells

Ballast or roughage

Stimulate the peristalsis

IAH 2007

24

This give an overview of the main functions of the two main species of symbiotic bacteria The role of the dextrorotatory lactic acids such as propionic acid has been mentioned above.

24

IV. Low grade pancreatitis

liver
Toxic bile

Common bile duct

pancreas

Toxic bile leaks unto head of exocrine pancreas: end result is maldigestion
IAH 2007 25

Due to the retrograde leaking of toxic bile into the pancreatic duct, a low grade exocrine pancreatitis is seen over time. This will impair the ability of the pancreas to secrete digestive juices, and a maldigestion will ensue. In some patients the pancreatitis is severe enough to cause a rise in the amylase level, but this is rare. If one does special tests, though, such as a CDSA (Comprehensive Diagnostic Stool Analysis), a number of undigested food fibers are seen in in the stool of these patients.

25

Mucosal support
Four R Regime of mucosal support Remove all noxious factors
Food Homotoxins

Replace all factors mucosa need

Nutrients ENERGY (Catalysts)

Repair the gut lining Reinoculate good bacteria

IAH 2007

26

The way to approach the leaky gut is through a 4 R regime, that of remove, replace, repair and reinnoculate. This regime will aim to remove all noxious toxins and pathogenic bacteria, as well as to replace all the nutrients which are needed for the body to regulate and especially for the enterocytes to ensure health of the gut lining. The repair need to be supported with specific antihomotoxic medicine. Lastly the inoculation of live bacteria should complete the regime.

26

Homotoxicology approach

IAH 2007

27

This antihomotoxic regime is used for patients who are seen to have a leaky gut. When one treats diseases which are accompanied by a leaky gut, we see that the three pillars will go a long way to treat this component as well, as the basic organ support of Mucosa compositum and catalysts are included in most of the advanced three pillar therapy schemes. Nux vomica-Homaccord is a very good functiotropic remedy in the case of any gut syndrome, and Hepar compositum has a colonic and pancreatic extract in it, which will support the gut and pancreas further. If there are symptoms of moderate to severe pancreatitis one can add Momordica compositum, but in most cases Hepar compositum will be sufficient. As the pancrestitis is low grade. Traumeel and organ extracts are used to induce the T reg cells in the gut lining, and restore tolerance in this way, as well as reduce the inflammation.

27

The Induction of Immune Tolerance over the Gut Lining

IAH 2007

This section is of utmost importance, as most of the immunomodulation we do can be explained according to this working mechanism. The mucosal surfaces lean themselves very well to the manipulation of the local and systemic immune system. The GALT is part of the MALT, (Mucosa Associated Lymph Tissue) , and it is well known that cells migrate between the different surfaces. This means that the cells which are primed in the gut lining can also have a primary effect on the Nasal associated lymphoid tissue, or NALT, the BALT or bronchial associated lymphoid tissue as well as the VALT(vaginal associated lymphoid tissue) Furthermore migrate these cells also to other areas of the body, which implies that the whole immune system can be regulated over the gut lining. The gut immune system is peculiar in that it responds differently to different concentrations of antigens, TH 3 cells, which are a type of regulatory T cell which can be induced by external antigens, are especially abundant in the mucosal surfaces, therefore driving responses towards tolerance in the mucosae and elsewhere in the body. This can be used successfully in therapeutic applications.

28

Oral tolerance and immunological bystander reaction I

IAH 2007

29

The plants, organs, venoms and suis organs are contained as a low dose antigen in the various antihomotoxic medicine. It is well known from the work of Weiner, Heine and others, that low doses of antigens stimulate a different kind of immune response (maybe through the different dendritic cells which process these antigens) . The immune response is different to the exposure which is short lived and also with a low dose of antigen. The first step is of course the ingesting of the amino acid containing substances. The body will see this as foreign and it will be engulfed by a antigen presenting cell, (APC) either a dendritic cell, or a macrophage. In the APC, the protein is then processed into small chains of amino acids (mainly 5-15)

29

Oral tolerance and immunological bystander reaction II

IAH 2007

30

The chains of amino acids are now bound to the major histocompatibility complex, the MCH, and is presented on the outside of the cell This is called the epitope. (That part of an antigenic molecule to which the t-cell receptor responds,) Together with the MCH complex it forms a motif (literally a recurring sequence) which is recognized by the T cell receptor. The T cells normally circulate as nave TH0 cells. These cells will scan the environment for these presented epitopes. Due to the concentration and the type of APCs active, the nave T cells will be transformed into TH3 cells. These are regulatory type of cells, and will down regulate the TH1 secreted Pro inflammatory cytokines (see lecture on immune modulation) These TH3 cells will now migrate into the lymph nodes and be cloned to millions of copies of TH3 cells. A different TH3 cell will be created for each different motif. This TH3 cells primed by Arnica, TH3 cells primed by Chamomile. Etc.

30

Oral tolerance and immunological bystander reaction III

IAH 2007

31

If there is a site of inflammation in the body, say an inflamed joint, the TH 3 cells will be attracted to the site of inflammation through chemotaxis.

31

Oral tolerance and immunological bystander reaction IV

IAH 2007

32

Once at the site of inflammation, TGF beta, the primary cytokine of the TH3 cell will be secreted, and this will effect down regulation of the TH1 cytokines, as well as it will start tissue repair. According to the homeopathic simile principle, it is postulated that each primed TH3 cell for the different plants or organs, will be specific in down regulating the TH1 cell which were induced by a corresponding toxin, This principle is also applied in so called Oral Tolerance Therapy, where a tissue is fed over the gut lining in order to down regulate inflammation at a distant part of the body. For instance, in hepatitis B, the viral envelope protein is fed over the gut lining in order to prevent the damage by the hepatitis B virus. In Multiple sclerosis, scientists have fed patients myelin basic protein over the gut lining to induce tolerance to the MBP in the brain of these patients. In the case of the substances in homotoxicology, which are used to induce the tolerance, we can talk of a bystander reaction. The plant is not the toxin which has start the disease, yet the substance can induce TH3 cells which are capable of reducing inflammation. The substance is thus a bystander which will induce a meaningful immune response. We thus use this principle in basic immune modulation by inducing TH3 cells which down regulate inflammation, but also by giving organ preparations over the gut lining, which will then induce tolerance in that organ (in case of autoimmunity) or tolerance in the case of allergy.

32

Systemic Gastroenterology

Antihomotoxic Pharmacy

IAH 2007

Now to the practical application of the above

33

Treatment plan on the DET

Detoxification

Cellular activation

Organ regulation and immunomodulation

plants

minerals

catalysts

nosodes venoms sarcodes

plants

minerals

IAH 2007

34

As general rule, we apply the three pillars also in disease of the gut. See the lecture on formulating a treatment plan and the Three pillars

34

Aphthous ulceration
Painful ulcers in the mouth and the gums Often a sign of Epstein Barr Virus or Cytomegalovirus
reactivation Homotoxicological treatment Gastricumeel (not Traumeel in this case)
inflammation

orodermal

IAH 2007

35

Aphthous ulceration is often seen in run down patients, but also can be a sign of reactivation of one of the deeper herpes viruses, such as Epstein Barr or Cytolomegalovirus. In the latter case, the disease is in the impregnation phase, but the ulceration is in the inflammation phase. The treatment is thus a simple mixed preparation for the ulceration,namely Gastricumeel. Traumeel is used in the case of stomatitis induced by chemotherapy. The mouth is rinsed 5x a day with one ampoule of Traumeel in a bit of water.

35

Gastroesophageal reflux disease (GERD)

Reflux very common 25 million Americans Lower esophageal sphincter weakened: acid reflux into alkaline
esophagus

IAH 2007

36

Gastroesophageal (GERD) reflux is very common nowadays. One just has to look at the amount of advertisement which is done for over the counter products done for this on the television, and it is clear that this is a common problem. This is also one of the diseases which illustrate the theory of disease progression very well, as postulated by Reckeweg.(see below)

36

Gastroesophageal reflux disease (GERD)

Chemical burn Develop a problem with the mucosa Cancerous change Barretts esophagus (pre-cancerous state)

IAH 2007

37

The lower esophageal sphincter is really only a high pressure area where the esophagus is crossing through the diaphragm. Many substances, like peppermint and coffee, will relax this area, with the subsequent effect that acid and gastric contents will leak into the esophagus. A high pressure in the abdomen, or a change in the alignment of the stomach , in for instance in pregnancy, can also cause a reflux of acid into the esophagus. In severe cases the chronic inflammation of the lower esophagus will cause a change in the mucosal lining of the esophagus, which eventually lead to the so called Barretts esophagus.

37

The Disease Evolution Table

Excretion Phase

Inflammation Phase

Deposition Phase

Impregnation Phase

Degeneration Phase

Dedifferentiation Phase

Acute inflammation

Chronic inflammation

Barretts esophagus

IAH 2007

38

With chronic GERD, we see a progression from first the acute inflammatory state in the esophageal mucosal membrane, to a state of chronic inflammation. If the homotoxins is not removed as in this case the toxin is the acid in an alkaline environment, the so called Barretts esophagus will ensue. Barretts esophagus is a pre cancerous state. This is an illustration of disease progression as we see on the DET. Therefore patients with GERD should be followed very closely with regular gastroscopies. This fact should not be forgotten if patients are treated with biological therapy alone. It is commonly done when patients are on therapies such as H2 blockers.

38

Treatment of gastroesophageal reflux disease (GERD) Gastricumeel Nux vomica-Homaccord Mucosa compositum Pulsatilla compositum

IAH 2007

39

The treatment of GERD can be single or adjuvant to conventional treatment, depending on the severity of the case. In the case of Barrettts esophagus, a dual therapy is almost mandatory, as the biological therapy will afford the support of the immune system and support the mucosa, whereas the H2 blockers will mostly reduce the acid, till the regulation is such that the H2 blocker can be stopped. The so called Nissens operation, which is done to increase the pressure of the gastro esophageal junction only has limited success and a number of complications. It is thus only done in selected patients today, mostly as a endocsopic procedure. The biological therpy consist of a basic preparation, Gastricumeel (see next slide) Nux vomica-Homaccord, and Mucosa compositum affords the support of the tissues, and Mucosa compositum, due to the suis organs in there is at the same time an immunomodulator. Lastly, Pulstatilla will work both as a symptomatic preparation, but also as a catalyst, as Reckeweg postulated that all hormones in dilution (as is Cortisone here in a D28), will act as a catalyst. Apart from this, Pulstailla will also support the connective tissue, and activate the matrix. In more severe cases this can replace the Gastricumeel as a basic preparation as well.

39

The composition of Gastricumeel

1. Argentum nitricum (Silver nitrate) Meteorism, gastritis, gastrocardial symptom complex, ulcus ventriculi 2. Acidum arsenicosum (Arsenicum album) Burning abdominal pain, gastritis, diarrhea 3. Pulsatilla (wind flower) Meteorism, dyspepsia, for mucodermal reaction phases

IAH 2007

40

The next two slides depict the so called materia medica for the ingredients of Gastricumeel. As depicted, this is very suited to treat symptoms of GERD, but also of peptic ulceration.

40

The composition of Gastricumeel

4. Nux vomica (vomit nut) Gastrointestinal and liver preparation, spasm after the indulgence of stimulants (coffee, alcohol, nicotine) 5. Carbo vegetabilis (wood charcoal) Dyspepsia, flatulence, burning abdominal pain, homotoxin absorption 6. Antimonium crudum (black antimony) Sensation of fullness, abdominal pain, intolerance to alcohol

IAH 2007

41

41

Treatment of gastroesophageal reflux disease (GERD) Passive measures No tight clothes Avoid heavy lifting Lift head of the bed at night Last meal about four hours before bed

IAH 2007

42

The passive measures, which are aimed at reducing the mecahnical pressure in the abdomen, should not be forgotten. These simple measures often offers a lot of relief on their own.

42

Peptic ulcer disease

Gastric ulceration Acid often low or normal Associated with higher incidence of cancer Often part of Pernicous Anemia (PA) These patients also have Vitamin B12 deficiency

IAH 2007

43

Peptic ulceration is another disease which is ubiquitous today. The gut brain axis also will play a role here , and toxins like cigarette smoke, but also a number of conventional drugs, like NSAIDs and cortisol as well as chemotherapy contribute towards this. A difference should be made between gastric ulceration and duodenal ulceration In the case of gastric ulceration there is often a low gastric acid, and anti acids are not effective. Gastric ulceration should be treated with more caution, as there is a high incidence of cancerous change associated with this. It can also be part of Pernicious Anaemia (PA), where there are antibodies to the parietal cells in the stomach lining. This is an autoimmune disease and can be associated with vitiligo, but also with Vit B deficiency, as the parietal cells will secrete the intrinsic factor needed for the absorption of Vit B12 orally. Atrophic gastritis also is part of this disease picture.

43

Peptic ulcer disease

Duodenal ulceration Related to hyperacidity Helicobacter pylori infection often present Both can be caused by NSAIDs like aspirin, ibuprofen,
diclofenac (mostly Cox-1-inhibitors, more than Cox-2)

IAH 2007

44

Duodenal ulceration on the other hand, is almost always associated with a high acid secretion and also with a high incidence of Helicobacter Pylori. Both the gastric as well as the duodenal ulceration can contributed to by the use of NSAIDS. These, as we mentioned above regarding the leaky gut, can in fact directly damage the mucosa, but also interfere with the metabolism of the mucosal cells, and therefore can cause tissue breakdown, and subsequently ulceration.

44

Treatment
Often an adjuvant treatment Mild to moderate forms can be treated with antihomotoxics alone (Regular follow ups) Helps to heal ulcer quicker and relapses are longer apart H. pylori can also be treated without antibiotics Chronic association connected with cancer

IAH 2007

45

Care should be taken not to treat patients with progressive disease with only biological therapy. Often a combination therapy can go a long way to promote tissue healing and to keep the patient in remission for longer periods of time, or even eradicate the disease earlier. Mild to moderate forms deserve a trial of antihomotoxic therapy alone, but there should be regular follow ups in these patients with endoscopy, especially in gastric ulceration the disease progression towards cancer should be a constant concern. With duodenal ulceration other complications, such as perforation, etc must also be kept in mind. Even H. Pylori can be treated with biological therapy alone, as was seen on a study by Karl Heinz Ricken.

45

Treatment
H. pylori can also be treated without antibiotics Study by Karl-Heinz Ricken with Nux vomica-Homaccord,
Lymphomyosot and Gastricumeel Ricken K-H. The antihomotoxic treatment of dyspepsia and Helicobacter pylori. Biological therapy 1997; No.3: 56-71

IAH 2007

46

If the patient has mild to moderate disease, or is intolerant to triple therapy, a trial of therapy with antihomotxic treatment can be started. The efficacy of this was documented by Karl Heinz Ricken in 1996 (see reference above), where he used a combination of Nux vomica-Homaccord, Lymphomyosot, as well as Gastricumeel, and could show an eradication of H. Pylori after several weeks.

46

Peptic ulceration
Symptomatic
Basic medication

Gastricumeel or Duodenoheel

Support regulation

Three pillars

Detox-Kit advanced first basic after the acute stage Mucosa compositum

Organ strengthening and cellular activation

IAH 2007

47

The treatment for peptic ulceration follows the three pillar approach. This condition is in the degenerative phase of the DET, or in the impregnation phase if it is still in the phase where there is only a leaky gut. The approach is thus to use all three pillars of homotoxicology. Gastricumeel we already encountered in the treatment of aphtous ulceration. It was originally designed to treat conditions of the gastric mucosa and stomach. A simple basic combination, it displays the Burgi effect. Duodenoheel on the other hand, is used for conditions lower in the upper GIT, however, in experience, many patients in this region will also respond to Gastricumeel. It is thus worth switching if the desired results are not seen in a few visits. The three pillars classically include the advanced and basic detox and drainage. Especially the Nux vomica homoaccord in the detox Kit has a functiotropic effect on the liver and the gut, and therefore not only functions to support the detox and drainage, but the gut itself. Mucosa compositum is a mandatory compositum if it is available, and so aqre the catalysts. However, in countries where the above is not available, Pulsatilla compsoitum is a valuable alternative, although this will take longer.

47

Antihomotxic medication for liver and gall bladder support

Nux vomica-Homaccord Injeel-Chol Chelidonium-Homaccord Hepar compositum Hepeel

IAH 2007

48

Various medications are available to fit into the three pillar concept for treatment. Nux vomica-Homaccord is the universal functiotropic medication in potency chord for the treatment of liver and gut disorders. Although classically used after overindulgence of alcohol and coffee, Nux vomicaHomaccord has been conceived to be functiotropic for the liver and the gut. This means that the ingredients will support the function of the liver and the gut. This is in difference to the composita, which classically contain tissue extracts as well as catalysts, and form part of tissue support. Hepeel on the other hand, being a basic combination, also has been shown in in vitro experiments, as having anti oxidant and anti proliferative actions. It showed that even combinations with plants and minerals can also be used for organ support. Chelidonium-Homaccord, and Injeel-Chol are used when the gall bladder or bile flow has to be supported.

48

Cholecystitis and gall stones

Injeel-Chol Chelidonium-Homaccord Do not use these drainage preparations if there is obstruction of
the bile duct

IAH 2007

49

As mentioned in the previous slide, these products are specially used for gall baldder problems. Chelidonium-Homaccord is used for gall stones, but can also be used in cholecystitis. Injeel-Chol not only supports the gall bladder and bile flow, but also has an effect on the liver and thus works deeper than Chelidonium-Homaccord. However, these should not be used if there is an obstruction to the bile flow, like is seen when a large stone gets lodged in the bile duct. When there are only small stones, or sludge, the products can be used safely. Chelidonium-Homaccord is often used for longer periods of time, up to three or four months, and the progress can be followed with ultrasound.

49

Cholecystitis
Spascupreel New cohort study comparing it to butyl scopolamine bromide
(Buscopan) 70 % of these patients were suffering with acute spasms Comparable/superior to Buscopan Mller-Krampe B et al. Behandlung von Spasmen bei Kindern. Jatros Pd. 2004;25(4) 20-2.

IAH 2007

50

In acute cholecystitis, Spascupreel can be of tremendous value. It has a fast onset of action, and can be repeated every 15 minutes for up to 8 doses. In a study done by Mueller Krampe, a paediatrician, it was shown that Spascupreel is comparable, and even in some cases superior to scopolamine bromide in children suffering from abdominal spasm. If injectables are available and allowed, Spascupreel can be injected i.v. in acute cholecystitis for a faster relief.

50

Spascupreel tablets - injection solution

D6 D4 D3 D2

Colocynthis

Atropinum Agaricus Gelsemium sulfuricum Veratrum Passiflora Ammonium Magnesium incarnata bromatum phosphoricum Cuprum Chamomilla Aconitum sulfuricum
IAH 2007 51

Through the composition of plants and minerals, we have a combination therapy which contains classsic homeopathic constituents for spasm, such as cuprum, aconitum and magnesium phosphate. Atropinum is the basis of atropine, which is also used in conventional medicine for spasm of the smooth muscle. Colocynthis is effective for spasm which cause the patient to bend double. Chamomilla is one of the mainstays of analgesic treatment in homotoxicology. This medication can also be used for spasm of the striated muscle.

51

Hepatitis
Viral Toxic Environmental Alcoholic Drug-induced Autoimmune

IAH 2007

52

Hepatitis can have many aetiologies. Hepatitis is an inflammation and we also here see a disease progression along the six phase table, namely that of fatty infiltration of the liver going on to fibrosis and eventually cancer. It is thus quite important that the liver is supported during these disease processes, as oxidative damage as well s inflammation will cause the above disease progression. In some cases there is no conventional treatment available, and the biological therapy may be the single intervention, in others, the intervention may be adjuvant.

52

Viral hepatitis
Hepatitis viruses Oral-fecal transmitted:
A, E, enterically transmitted non-A, non-B

Blood and sexually transmitted:

B, C, D (Also called delta virus), G

IAH 2007

53

Many types of viruses can cause hepatitis, some of them oral faecal borne, some of them blood and sexually transmitted. For this reason the viruses transmitted through the latter route are also seen in drug addicts, for instance, and is transmitted by sharing needles. Many of these viruses can cause persistent infections, like for chronic active hepatitis and will go on to dedifferentiation and liver cancer. On the DET these diseases are always past the regulation division, in the impregnation phase( see lecture on viral infections) and will need the full three pillar treatment

53

Aims of antihomotoxic treatment of hepatitis Treat symptoms Support the liver function Prevent damage from toxins and viral activity In case of viral infection: increase cellular immunity

IAH 2007

54

The aims of treatment will be to treat symptoms, like nausea, fatigue, urticaria , arthralgia etc, but also to support the liver function, to prevent damage or even try and reverse tissue damage through organ support, and in case of viral infection, to support the cellular immunity in order to give the body a chance to eliminate the virus.

54

Hepatitis
Symptomatic
Basic medication

Vomitusheel Engystol (Viral protection)

Support regulation

Three pillars

Detox-Kit advanced first basic after the acute stage Hepar compositum (part of advanced detox) Hepeel Coenzyme compositum Ubichinon compositum

IAH 2007

55

With viral hepatitis, we often see symptoms long before the patient becomes icteric or jaundiced. A high index of suspicion should be present, when there severe vomiting, myalgia and arthralgia as well as severe headache in a patient. Although three pillars are used in these patients, the order of doing them is reversed. The detoxification should be a later event in these patients, as the liver gets overloaded during the detoxification process. In these cases, Engystol is added early as well as Hepeel together with the advanced detox which is more supportive. It contains the product Hepar compositum, which will support the liver tissue. Hepeel is especially important in these patients with long standing chronic hepatitis, as it has been shown to have antiproliferative action as well as antioxidant action, and as such can prevent disease progression. Drainage is always done as a late event in these patients, and only should be attempted when the liver functions have stabilized and the viral counts came down.

55

Functional disturbances of motility

Irritable bowel syndrome 10-20% of people Starts in adolescence and symptoms are not constant New evidence suggests a major influence of stress This is mediated via the brain-gut axis

IAH 2007

56

Irritable bowel syndrome (IBS) is very common nowadays, and whereas before thought to be a psychosomatic disease, is now well recognized as including disturbances of the gut brain axis. This is compounded by stress, and we saw above, the stress have an influence on the gut lining. In IBS though there is also a disturbed communication between the gut and the brain, and there is a heightened sensory experience of pain in these patients. It is thus important to add medication which works on the emotions and the brain.

56

Functional disturbances of motility

Irritable bowel syndrome Medication Nux vomica-Homaccord (Colocynthis) Hepeel (if Nux vomica-Homaccord is not enough) Spascupreel Nervoheel Tonico-Injeel

IAH 2007

57

The mainstay of the treatment here is the functiotropic Nux vomica-Homaccord, which will treat colic, bloating as well as constipation. Hepeel can be added if there is a lot of bloating, and Nux vomica is not enough. Spascupreel can be added on demand when there is a component of spasm, and can be given in the acute dose of one tablet every 15 minutes for up to two hours. To treat the brain gut axis, Nervoheel can be added in the case of milder anxiety syndromes, whereas Tonico Injeel is better added in patients who are overworked and on the brink of collapse or burn out.

57

Constipation
Discourage laxative abuse Fiber and fruit and vegetables Antihomotoxic medications Graphites-Homaccord Nux vomica-Homaccord Due to the longer contact time with the mucosa, more toxins can
be absorbed Hepar compositum (contains colon suis)

IAH 2007

58

Constipation is not a disease as such, but has a high level of discomfort for the patients suffering from this condition. It can be temporary in patients who for instance travel, and change their diet, or can be chronic in some patients. Laxative abuse should be discouraged, as it tends to cause a rebound constipation. The diet should be adjusted accordingly to contain fresh fruit and vegetables and natural fibre. The antihomotoxic medications, such as Graphites-Homaccord and Nux vomica can be very helpful. Nux vomica-Homaccord is often used in patients with severe persistent constipation and is also useful in children suffering from constipation. It is normally given for a couple of weeks. In cases with long standing or stubborn constipation, a tissue support in the form of Hepar compositum is added. This also contains and extract of colon tissue, and can thus support the large bowel.

58

Diarrhea
Increase secretion of chloride ions into the lumen through the
tight junction Water follows, with loose stools Protective mechanism If too long or mixed with blood and mucous, it should be investigated Most common cause are viruses, enteroviruses (Coxsackie) or also Rota viruses (change of season)

IAH 2007

59

Diarrhea is seen in homotoxicology as part of the excretion phase, and therefore as a purposeful defense against toxins, which could be foul food, bacterial or viral infections etc. The infective diarrhea called gastroenteritis, is one of the most common diseases and still a major cause of mortality in poorer countries. However, when it is persistent, or mixed with mucous and blood it can be part of a more severe disease picture, such as Inflammatory Bowel Disease.

59

Treatment of simple diarrhea

Diarrheel Veratrum-Homaccord Spascupreel

IAH 2007

60

Simple diarrhoa is treated with supportive measures, like dehydration and replacement of electrolytes. This is mandatory and can save many lives in the incidence of gastroenteritis in small infants. Diarrheel is a basic combination, which will gently reduce the diarrhoa, without suppressing it as seen with the commercial products available. It will thus allow the body to excrete the offender, but still reduce all the symptoms concomitantly. Its combination is depicted in the next slide. Veratrum album is a plant which classically is used when there is severe coldness , clammy sweat and collapse associated with the diarrhoa. Veratrum-Homaccord can thus be added if this is a feature of the illness in the patient. Spascupreel can be added when there is severe cramping.

60

Actions of Diarrheel

Mucosal action Arg nit

Gastro enteritis Veratrum (weak) Arsen alb (cold) Colchicum

Colic

Diarrhea

Colocynthis

Tormentilla Merc corr Podophyllum Ars alb

IAH 2007

61

This slide depicts the actions of Diarrheel S.

61

Inflammatory bowel disease

IBD Crohns disease Ulcerative colitis

IAH 2007

62

These diseases, which needs to be distinguished from the simple diarrhoa, are treated with advanced treatment, which will be discussed in more advanced courses.

62