http://www.meactionuk.org.uk/Interstitial_cystitis_and_Chronic_Fatigue_Syndr
ome.htm
http://www.meactionuk.org.uk/Interstitial_cystitis_and_Chronic_Fatigue_Syndr
ome.pdf
Interstitial cystitis and Chronic Fatigue Syndrome
Margaret Williams 26th August 2009
That there is a concerted campaign by members of the Wessely School to
re-classify as a single somatoform disorder various disparate syndromes
whose aetiology remains undetermined cannot be disputed.
It is worth noting that the British Medical Journal recently carried a
well-structured Clinical Review of interstitial cystitis, a condition
associated with gross bladder wall changes, and painful bladder syndrome,
which exhibits the same symptoms but lacks gross cystoscopic findings (Serge
Marinkovic et al; BMJ 8th August 2009:339:337-342). The authors stated that
patients with IC are 100 times more likely to have irritable bowel syndrome
and are 30 times more likely to have systemic lupus erythematosus, and that
other associated chronic illnesses include fibromyalgia and chronic fatigue
syndrome. The authors provided a compelling but unconfirmed theory - based
on evidence that the authors say represents the majority opinion of
researchers actively involved in the field - of likely autoimmune causation:
"The pathological features of bladder epithelial damage and related blood
vessel transitions in the absence of infection have been recognised for more
than 100 years. One theory is that increased permeability of the protective
glycosaminoglycan lining of the bladder epithelium causes potassium (and)
toxins to leak into the mucosal interstitium, activating mast cells and
generating an autoimmune response. Mast cells produce immune reactive
chemicals, which in turn cause generalised bladder inflammation and bladder
mucosal damage through the presence of tachykinins and cytokines. These
further mediate the release of histamine, tumour necrosis factor, chymase,
tryptase, and prostaglandins. Finally, inflammatory agents sensitise
bladder neurones, producing pelvic and bladder pain...Some patients have
exacerbations of their symptoms after ingesting certain food or
dinks..Urothelial cell cultures express abnormal gene variants. When
urothelial biopsies.were subjected to stretch.they released significantly
higher concentrations of ATP than control biopsies, suggesting that ATP
plays an important role in this syndrome. An investigation of cultured
bladder urothelial cells.showed that such cells had higher than normal
concentrations of ATP, which decreases the ability of the bladder wall to
conduct potassium ions.which again indicates that impaired potassium
conduction is involved in the pathophysiology of interstitial cystitis".
Professor Simon Wessely, champion of cognitive behavioural therapy and
proponent of the psychosocial model of ME/CFS, seems to reject outright any
autoimmune or allergic component: "The article.details associations with
fibromyalgia, chronic fatigue syndrome and, strikingly, a 100-fold increased
risk of irritable bowel syndrome - all of which have good evidence for the
role, at least in part, of psychological factors in the their aetiology or
maintenance.It is highly possible that psychological factors have an
aetiological contribution to conditions such as painful bladder syndrome.
Such disorders, where physical pathology cannot fully account for symptoms,
are known as 'medically unexplained' or 'functional' (somatic) syndromes.It
has been proposed (citing his own Lancet paper 1999:354:936-939) that they
may be the same underlying disorder manifesting itself in different bodily
systems.Dr Marinkovic, however, despite drawing out the evidence for such a
description, seems to resist the inference, making no mention of
psychological factors even as possible contributors to the aetiology.The
experience of other functional somatic syndromes.is that a biopsychosocial
approach is the foundation of successful cognitive behavioural therapy.
This.surely deserves a place in any review (of) painful bladder syndrome"
( http://www.bmj.com/cgi/eletters/339/jul31_2/b2707#218935 ).
People must decide for themselves whether or not, based on the evidence, Dr
Marinkovic did "draw out the evidence" that IC is a functional somatic
disorder, and which of the two theories is the more convincing.
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