Gastrointestinal Disease

Gastrointestinal Disease
IAH AC Gastrointestinal Disease
© IAH 2007
1
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
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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 of300-600 square metres , and through the luminal surface will
be in direct contact with toxins, gases and of course the nutrients that is needed.
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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
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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
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liver
5
blood
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receptor for e.g.
corticotrophic hormone
tight junction
immune system
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bacteria
food particles
1.
2
mucous and
unstirred water layer
gut lumen
the intestinal barriers
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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.
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The mucosal barrier
• From the gastrointestinal
brochure
Heel Inc., USA, October 2004:
Text: Alta Smit
Graphics: Andrew Mingione
© IAH 2007
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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)
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• 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
T cell response, non-specific
local immune response, with
mast cell as transducer
© IAH 2007
activation
response
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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 APC’s(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 Crohn’s disease.
A large body of research is now available in these individual differences in the
immune response in the gut.
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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
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The epithelium itself plays a very important role in immunity.
Through the integrity of the Tight Junction, the size of antigens are 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.
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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
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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
Homöopathische Substanzen aus der Antihomotoxischen Medizin modulieren die
Synthese von TGF-ß1 in menschlichen Vollblutkulturen. Biologische Medizin 2001;nr 2 6165
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 Crohn’s 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.
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Breast is best!!
Photos: WHO Ethiopia
© IAH 2007
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The gut lining in an infant is wide open to allow for the absorbtion of vital factors
in breast milk, such as transfer factors amongst others.
The close 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.
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Vaccination
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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.
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Environment
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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.
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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
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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.
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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
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Many systemic diseases are now linked to mucosal distress, such as IBD, where
it is for instance known that patients suffering from Crohn’s 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 Crohn’s 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 Crohn’s 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):
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© IAH 2007
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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.
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Vicious cycles of changed permeability
• Immune activation or suppression
• Food intolerance
• Hepatic overload
• Bacterial dysbiosis
• Low grade pancreatitis (partially digested foods)
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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.
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I. Allergy and inflammation
• Locally in gut
• Neutrophils(frustrated neutrophil)
• Lymphocytes
• Chemical mediators
• Mast cells, histamine
• Bradykinin
• Serotonin
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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 Crohn’s.
This will set of another vicious cycle of inflammation and tissue damage.
In diseases such as Crohn’s , 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.
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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
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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.
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© IAH 2007
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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.
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Food allergies
Positive skin test
Positive test meal
Peanut
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Chicken egg
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Cow’s milk
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7
Soy
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2
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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
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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
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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.
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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
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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.
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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
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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).
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Gut milieu
luminal contents and pH
bacteria
immunity:
strains important
e.g. Acidophilus DDS, Rhamnosus
barriers see
before
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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
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Some symbiotic bacteria
Ingredient
Function
Lactobacilli: main species:
lactobacillus acidophilus
Most important in aerobic milieu; assist
apart from other functions formation of
dextro-rotatory lactic acid
Bifidobacteria: main species:
bifidobacterium longum
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
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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.
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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
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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.
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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
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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.
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Homotoxicology approach
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This antihomotoxic regime is used for patients who are seen to have a leaky gut.
When one treats disease which are accompanied with 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.
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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 respond 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.
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Oral tolerance and
immunological bystander reaction I
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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)
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Oral tolerance and
immunological bystander reaction II
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The chains of amino acids is 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 naïve TH0 cells. These cells will scan the
environment for these presented epitopes. Due to the concentration and the type
of APC’s active, the naïve 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.
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Oral tolerance and
immunological bystander reaction III
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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.
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Oral tolerance and
immunological bystander reaction IV
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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 vitamin B virus.
In Multiple sclerosis, scientist shave 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.
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Systemic Gastroenenterology
Antihomotoxic Pharmacy
© IAH 2007
Now to the practical application of the above
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Treatment plan on the DET
Cellular activation
Detoxification
plants
minerals
plants
minerals
catalysts
Organ regulation and
immunomodulation
nosodes
venoms
sarcodes
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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
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Aphtous 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
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Aphtous 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
• Barrett’s 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 Barrett’s esophagus.
37
The Disease Evolution Table
Excretion
Phase
Inflammation
Phase
Deposition
Phase
Acute
inflammation
Impregnation
Phase
Chronic
inflammation
Degeneration
Phase
Dedifferentiation
Phase
Barrett’s
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.
Barrett’s 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 NSAID’s 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 irradiate 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
Hoamaccord, Lymphomyosot, as well as Gastricumeel, and could show an
eradiation 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 deference to the composita, which classically contains tissue extracts
as well as catalysts, and forms 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 support 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 get 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 linger 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
• Müller-Krampe B et al. Behandlung von Spasmen bei Kindern.
Jatros Päd. 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
Atropinum
Agaricus
Gelsemium
sulfuricum Veratrum
Passiflora
Ammonium
Magnesium
incarnata
bromatum
phosphoricum
Cuprum
Chamomilla
Aconitum
sulfuricum
Colocynthis
© 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
Gastro
enteritis
Colic
Diarrhea
Arg nit
Veratrum
(weak)
Arsen
alb (cold)
Colchicum
Colocynthis
Tormentilla
Merc corr
Podophyllum
Ars alb
© IAH 2007
61
This slide depicts the actions of Diarrheel S.
61
Inflammatory bowel disease
• IBD
• Crohn’s 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