Irritable Bowel Syndrome & parasites

1983:
"Parasitic infection should be considered
in patients with vague gastrointestinal symptoms".
Millet, V. et al. Dig Dis Sci 1983 Apr;28(4):335-9

2004
"Blastocystis hominis was frequently demonstrated in the stool samples of IBS patients"
Am J Trop Med Hyg. 2004 Apr;70(4):383-5.

The advice for IBS is often to learn to live with symptoms, as the following message posted on an IBS message board, shows:

"I went to see my doctor about diarrhia, and pain and bloating. And she said, "You have ibs. There's nothing that can be done". About a year later, it was getting so bad I didn't even want to leave the house, I was getting so depressed, so I went back to her and said I wanted a second opinion, she sent me to a gastronologist. He listened to my complaints, and said to me "Well I have good news and I have bad news, the good news is I don't think you have cancer, the bad news is I think you have ibs and there is nothing I can do for you". So I went home more depressed than when I started out.
posted 2002

Medical specialists (gastroenterologists) mostly their advise patients that neither Dientamoeba fragilis nor B.hominis cause symptoms (see Medical Mismanagement).

Published research as far back as the 1940s clearly shows that both Blastocystis hominis and Dientamoeba fragilis are more common than the parasite Giardia, which is the bug most often tested for in those with digestive disorders. Blasto. hominis is the most common protozoan parasite to infect humans.

In 2000 researchers were interested enough in the possible connection between irritable bowel syndrome and parasitic infection to test over 1,000 people diagnosed with IBS. Their results confirmed parasites were significant in this group. An extremely, and much overlooked, aspect of the research was that parasite and ova testing results were not reliant on a single stool sample, the standard procedure for those with digestive complaints. Instead three samples were tested, and specialised lab testing was used,.

A In 2000 researchers in the United Kingdom tested stool samples of IBS patients using special collection and testing methods, as opposed to standard single stool tests, and found that more than 40% of IBS patients were infected with either Blastocystis hominis or Dientamoeba fragilis (unpublished research, 2000). Mixed infections are also common.

Other studies have shown that both Dientamoeba fragilis are found as commonly as giardia when these specific stool collection and testing methods are employed.

The London School of Hygiene & Tropical Medicine consider Blastocystis hominis "may be the most common parasite known to infect humans." Establishing Cultures of Entamoeba in vitro - on line)

Despite the fact that these parasites are commonly found in those diagnosed with IBS, the majority are not tested for the presence of these parasites. This is especially true if the treating physician mistakenly believes parasites are rare in western countries, or that D.fragilis and B.hominis are benign parasites not capable of causing illness.

Two-hundred and twenty-one people diagnosed with IBS responded to a survey on this site.
The question was: "Have you ever been tested for parasitic infection":

SYMPTOMS OF IRRITABLE BOWEL SYNDROME
Abdo pain, diarrhoea, cycling diarrhoea/constipation
bloating, nausea, fatigue.

SYMPTOMS OF DIENTAMOEBA FRAGILIS INFECTION:
(in order of the highest reported symptom):
Diarrhoea,
Abdo.pain
Abnormal stool (blood with mucus, loose)
Flatulence,
Fatigue or weakness
Alternating diarrhoea and constipation
Constipation,
Belching
Tenesmus (form of constipation)
Anorexia or malaise
D.Fragilis: A Review with Notes. Yang & Scholten (1976)

The symptoms of a Blasto. hominis infection are the same as for D.fragilis.

The degree of symptoms depends on the severity of the infection. In milder infections bloating, pain diarrhoea and/or constipation are common. In chronic cases the symptoms may also include: weight loss & fatigue and feeling constantly unwell.

Reasons for variations in the severity of infection can be due to a number of factors, including the strain of the infecting parasite and the immune response of the host.

HOW COMMON ARE THESE PARASITES?
Doctors in western countries generally consider D.fragilis and Blasto. infections to be rare and most doctors believe parasitic infections affect only those people living in tropical regions or third world countries, or travellers to these regions:

TESTING FOR PARASITES
Specific info. about the importance of submitting the fecal samples in liquid preservative, and ensuring the samples are tested by a lab experienced in testing for these parasites can be found under lab testing.

Yet even if all of these specialised collection and testing methods are used misdiagnosis can still occur because parasites shed irregularly in faeces, and may not be present on the day the samples are submitted.

A minimum of 3 samples is, according to published lit. on D.fragilis, approx. 87% accurate. Obviously the more samples submitted the more chance of detection, but the cost is often prohibitive. The following e-mail from a parasitologist shows that approx. 5 out of every 100 people may be left without an answer to their baffling digestive problems:

Parasites firmly adhere to the bowel wall laxatives can increase the chance of detection by forcing the parasites out of the bowel. However, the ingredients of some laxatives can interfere with stool test results. Ask your doctor or email me for more info.

In March 2000, stool samples were collected from 17 symptomatic patients to test for parasites. All patients had suffered at least one of the following symptoms: nausea, vomiting, diarrhoea, abdo. cramps, bloating. Two stool samples were requested for testing at the Provincial Reference Laboratory (a public laboratory in Canada). A further 10 symptomatic individuals were evaluated by their physicians and 2 stool samples from each were sent to 7 different laboratories:

The govt. lab reported all parasites found in the samples, but 5 private labs DID NOT report all parasites, in particular Blastocystis hominis, as they believed this parasite was non-pathogenic (not a cause of symptoms) and therefore they did not actively search for it. If it was found they did not report it to the treating physician.
(B. HOMINIS: A NEW PATHOGEN IN DAY-CARE CENTRES? Canada Communicable Disease Report - Volume 27-09, 1 May 2001)

Unfortunately such practice is not confined to Canadian labs, but occurs in many western countries, including Australia.

In 1999 I surveyed a number of high profile laboratories in Sydney, Australia and was informed that D.fragilis is either not tested for, or if found, it is not reported, unless a specific request is made by the physician.

Parasites firmly adhere to the bowel wall laxatives can increase the chance of detection by forcing the parasites out of the bowel. However, the ingredients of some laxatives can interfere with stool test results. Ask your doctor or email me for more info.

General practitioners are often not familiar with the specific
collection and testing methods crucial to diagnose certain parasitic infections. As well as this they are all too often unaware that many of the laboratories to which they entrust their patients samples may not always be equipped to detect D.fragilis & Blasto. hominis:

....physicians should perhaps be more concerned about the competence of the laboratory to which they submit samples and be better informed of techniques used routinely by the laboratory before accepting positive or negative reports at face value.
Yang & Scholten. AJTMH. Vol.26.,No.1;16-22

"Because competence to accurately diagnose parasitic infections is not easily obtained, physicians should perhaps be more concerned about the competency of the laboratory to which they submit their samples"
Yang & Scholten, D.fragilis: A review with notes. Am.Journal of TM&H, 1977

Our results suggest that a single stool specimen will miss many pathogenic protozoan infections in symptomatic people.
How many stool samples are necessary to detect pathogenic intestinal protozoa?
Hiatt RA et al. AJTMH 1995

.....stool testing fails to detect Entamoeba histolytica in more than 30-40% of clinically suspected cases.
(Vinayak VK et al
Indian J Gastroenterol 1993

Interested in testing for parasites? If you live in Australia Histopath Labs will send out a 3 sample kit with instructions to your local dr. Please note that the lab will only send out the kits on the request of a registered general practitioner. For details of how to contact this lab email me.

A list of labs using specific types of testing to detect D.fragilis and Blasto. hominis is on the "Where to find help" section of this site.

SYMPTOMS:
The medical debate as to whether the parasites Dientamoeba fragilis and Blastocystis hominis are able to cause symptoms has continued more than 50 years. This is despite numerous medical reports published in peer reviewed medical journals implicating both of these parasites as being able to cause not only IBS type symptoms, but also in some cases colitis and bowel inflammation.

The majority of general practitioners are unfamiliar with these parasites, or the need for the special collection and testing methods necessary to diagnose them, or how to effectively treat them.

Medical specialists often advise patients that Dientamoeba fragilis and B.hominis do not cause syptoms (see Medical Mismanagement).

MISDIAGNOSES:

The following corrrespondence shows that misdiagnosis is common:

I have had IBS for over fifteen years. It was controllable with Modulon. In the summer of 1999 I couldn't control it so a stool sample came up with DF.
L. Ontario, Canada 14 July 2002

"I have just found your website and would like to add my story.
I had been complaining about my stomach for about a year, visiting my regular doctor and a gastro specialist. My doctor was at a loss for what it could be, and suggested possible IBS. The gastro guy said I had a very spastic colon and to go for an upper and lower GI series. That sounded too radical, so I instead went to a naturpath. She took me off wheat, which had dramatic results (good ones) - and for awhile I was convinced that was the problem. But symptoms still remained - fatigue, stomach rumbling, feeling unwell, very soft stools, etc.....
I was diagnosed with DF this past September (2001)."

"We are from Walkerton ON and as you probably know have had major water problems. My wife and daughter as many others had been diagnosed with IBS. however with followup tests my daughter now has Df."
emailed by D. July 01

"After 7 years of IBS diagnosis, 7 GI specialists, numerous MD's, D.Fragilis was found at GSDL. My symptoms have accumulated to add up to what otherwise has been called Gulf-War Syndrome."
emailed by D.W. June 01

"Many years ago (maybe 16) I was diagnosed with Irritable bowel after complaining about abdominal pain. since then I've sort of ignored the problems. A year ago I was diagnosed with MANY food sensitivities".
Stool tests eventually revealed infection with D.fragilis.

"After years of misery re - loose stools etc, diagnosed as irritable bowel I have been diagnosed with a moderate amount of D fragilis by Great Smokies Diagnostic laboratory."

"I have seen many doctors over the past 3 years, and had many stool tests. All have diagnosed me with irritable bowel. A new doctor recently ordered 3 stool tests in jar containing some kind of preservative - they came back positive for D.fragilis and B.hominis."
150
see also Medical Mismanagement

FOOD "SENSITIVITIES" & IBS:

Many people with IBS experience a worsening of their symptoms after certain foods are eaten. Wheat and dairy are high on the list of offending foods and by restricting these the symptoms are greatly reduced. Food cravings are not uncommon.

For 20 years symptoms of cycling diarrhoea/constipation had been diagnosed as IBS in a 31 yr old woman. Diagnosed in March 2001 with the parasite Blastoscystis hominis....she wrote: "Food definitely makes my problems worse and when eaten I become totally mentally/emotionally unstable."

The Specific Carbohydrate Diet has given many relief from the symptoms of IBS. The following research is of interest:

Foods rich in carbohydrates, as well as fatty food, coffee, alcohol and hot spices were most frequently reported to cause symptoms. The food score was higher in patients than in controls (p < 0.0001). In the IBS group higher scores were observed in patients with anxiety (p = 0.005), and females (p < 0.001), but the results were unrelated to IBS subgroup, referral status or BMI. The BMI did not differ between groups. Conclusion: A majority of IBS patients consider their symptoms to be related to meals. Especially foods rich in carbohydrates and fat cause problems.
Food-related gastrointestinal symptoms in the irritable bowel syndrome.
Simren M; Mansson A; Langkilde AM; Svedlund J; Abrahamsson H; Bengtsson U; Bjornsson ES
Digestion 2001;63(2):108-15

Why does restricting these types of foods help?

Pattern of excretion of D.fragilis following dietary adjustments:-
Researchers placed an infected subject on a diet of mainly carbohydrates. Between day 1 and 30 - increased numbers of D.f. were found. The subject was then placed on a protein diet and retesting began at day 60. Between day 60 to 80 less D.fragilis were excreted.
(D.fragilis. A review with notes...... J.Yang et al. AJTM&H 1977).

Parasites survive on the food we eat. Starchy foods are used to grow the organism in the laboratory:

"Rice starch is an essential addition in xenic cultures, and is ingested by D.fragilis trophozoites, together with bacteria".
"In the cytoplasm, digestive vacuoles were common and contained rice starch, myelin or bacteria".
"In stained smears, using higher magnification, food inclusions can be found and various bacteria, yeasts and Bacillus hominis may also be ingested.
D.fragilis: the unflaggelated human parasite. JJ Windsor & E.H.Johnson. Br.JBS 1999; 56: 293-306

ACCURATE DIAGNOSES IS OFTEN ONLY HALF THE BATTLE:
Unfortunately for many people an eventual positive test for parasitic infection is only half the battle! Click here for more.