Interview with Gastroenterologist from Mayo Clinic. “Discussion” points! I think it’s pretty good. What do you think?
1) Can you explain what is your current understanding of colon hydrotherapy? Is this something that you would discourage? What reservations do you have about it?
2)Being a GI you have undoubtedly learned that the GI contains 80-90 percent of our immune system. Just curious, have you by any chance read The Second Brain by Dr. Michael Gershon, cell biology professor at Columbia?
How familar are you with this notion of the enteric brain? Dr. Gershon said a) that colon hydrotherapy is useful for colonoscopy bowel prep and b) that oral preps are not good for the GI due to the damage done to the lumen and lining of the bowel. What are your thoughts on all of this?
Questions 3 through 6 are from other GIs who have been using colon hydrotherapy as an alternative bowel prep for colonoscopy
3) Obesity is an epidemic in this country. More and more people are turning to bariatric surgery, either in the way of gastric bypass or lap band to help them with this problem. As you know both of these procedures significantly diminish the patient’s ability to consume large volume of liquids. Wouldn’t CHT and the low volume oral prep associated with that cleanse be a nice option for these patients?
On that note, there are other medical conditions that could cause patients to have difficulty in consuming large volumes of liquids, such as gastroparesis. Can you talk about how CHT might also be a nice option for those patients?
4) Lets talk about patients with physical disabilities such as paralysis, neuropathy and severe arthritis leading to ambulation limitations: isn’t it a hazard to have them consume the typically large volume oral preps which results in them having to urgently run to the bathroom at least 7-10 times if not more? Wouldn’t these patients be better served by offering them CHT associated bowel preps where on average they need to go to the bathroom on 3-4 times and typically these bowel movements are not as urgent?
5) The biggest known obstacle in preventing a patient from proceeding with a colonoscopy is the bowel prep. On that fact alone, wouldn’t you as a physician be inclined to offer an alternative prep in order to get patients to schedule a colonoscopy? What other preps have you investigated?
6) Have you ever witnessed a bowel prep using CHT? Have you ever discussed the effectiveness of bowel preps using CHT with physicians who use them?
The following are questions that I would like to pose
7)Are you familiar with this recent study? Do you ever resort to sigmoidoscopy in lieu of colonoscopy due to patient resistance? Which do you prefer and why?
Study showing that this screening was effective “If someone, for example, was afraid of anesthesia, if they want a test where the prep is not so aggressive — they just take enemas as opposed to drinking laxatives, if they cannot spare a day… all those are good reasons if you want to go and have a (sigmoidoscopy),” Schoen said.
8) Dr. Shinya, the Doctor who invented colonoscopy-300K colonoscopies-analized intestinal appearance and intestinal disease.
linked CC to diabetes, heart disease prostate, breast cancer, obesity, high blood pressure
He found that proper diet and increased water intake prevents stagnation and toxic waste from accumulating in the bowel. Couldn’t colon hydrotherapy be an adjunct tool, when combined with increase of water intake and dietary changes, to removing any fecal buildup which should not be there?
9) Recently a Rush University Medical Center Study by Dr. Kathleen Shannon, a neurologist found that using tissue from colonoscopy could detect Parkinson’s Disease 10 years early. Did you hear about it?
This was the finding:
“Recent clinical and pathological evidence supports the notion that Parkinson’s disease may begin in the intestinal wall then spread through the nerves to the brain. Clinical signs of intestinal disease, such as constipation, [may precede] Parkinson’s disease diagnosis by more than a decade. These studies suggest it may one day be possible to use colonic tissue biopsy to predict who will develop motor Parkinson’s disease.”
Assuming it is true and goes forward, how do you think the medical community would promote colonoscopy on these grounds? Would it be even more important since it has another use? Wouldn’t there be room for other bowel preps like colon hydrotherapy?
10) New colon cancer drug, Stigvaga-Bayer drug intended for cancer that has progressed or spread- $9,350 per month, fatal liver toxicity in exchange for living 1.4 months longer than placebo. Are you familiar with with this new drug? How does this definition of success strike you, ie only 1.4 months longer than placebo? What other chronic constipation medications have you been inclined to use on your patients and what side effects if any, do they come with?
11) Breast cancer study linked to chronic constipation-Bowel Function and Breast Cancer in US Women-findings were
that there was a corrolation between women with constipation and retained fecal matter and breast cancer.
Are you familiar with it? It was from 1989. Do these findings prompt any concern over chronic constipation in women? How often do you see CC in your female patients? What do you consider normal bowel elimination, ie. per day, per week?
12) New CC drug approved:
“Linzess” (linaclotide) as a once-daily treatment for adult men and women suffering from irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC). What it does:
LINZESS binds to the GC-C receptor locally in the intestine, with no measurable blood plasma concentrations, resulting in an increase in both intracellular and extracellular concentrations of cyclic guanosine monophosphate (cGMP). Elevations in intracellular cGMP are believed to stimulate secretion of intestinal fluid and accelerate gastrointestinal transit resulting in increased frequency of bowel movements. Elevations in extracellular cGMP are believed to decrease activity of pain-sensing nerves, which is thought to be responsible for a reduction in intestinal pain, according to nonclinical models.
Can you help us understand these two physiological changes, i.e.…which one is more important-the stimulation of itestinal fluid or the decrease in pain sensing nerves?
13) What is your familiarity and/or opinion (if at all) on Dr. Ernest Tipper and and other doctors in the early 20th century who did studies on populations in Africa , which found that these cultures did not exhibit Western diseases ie, that these cultures eat much greater quantities of fruits and vegetables, do not cook their food and have 3 bowel movements per day which were also described as being bulky and whole and properly formed? Any thoughts on this?
14) Can you talk about your familiarity with the Townsend Letter? How useful is it to the medical community? Does it hold any value to them? Here is a link to medical professionals weighing in on colonics:
15) Effect of bowel cleansing on colonic transit in constipation due to slow transit or evacuation disorder. Have you ever come across this study?
16) Another recent study involving colon hydrotherapy out of Tokyo Japan-What are your thoughts?
The Influence of Colonic Irrigation on Human Intestinal Microbiota
Some references just in case of your own future interest
1. Fiorito J, Culpepper-Morgan A, Estabrook SG, et al. Hydrotherapy compared with PEG-ES lavage and aqueous sodium phosphate as bowel preparation for elective colonoscopy. American College of Gastroenterology Annual Meeting; Las Vegas, Nev; October 2006.
2. Galliani I, Santi P, Barratta B, et al. Effect of water irrigations on human colonic mucosa structure after sigmoidostomy. Dis Colon Rectum. 1987;30:453–456.
3. Koch SM, Uldao O, El Naggar K, et al. Colonic irrigation for defecation disorders after dynamic graciloplasty. Int J Colorectal Dis. 2008;23:195–200.
4. Koch SM, Rietveld MP, Govaert B, et al. Retrograde colonic irrigation for faecal incontinence after low anterior resection. Int J Colorectal Dis. 2009;24:1019–1022.
5. Sulkowski U, Boin C, Brockmann J, et al. The influence of caecostomy and colonic irrigation on pathophysiology and prognosis in acute experimental pancreatitis. Eur J Surg. 1993;159:287–291.